Department of Surgery, University of Washington and Harborview Medical Center, Seattle, Washington 98104, USA.
Surg Infect (Larchmt). 2010 Jun;11(3):307-10. doi: 10.1089/sur.2010.023.
The role of re-laparotomy in the management of intra-abdominal infection remains controversial. Two strategies have been used: Planned re-laparotomy or laparotomy on demand.
A review of the literature on this controversial subject was performed.
Although in the past, planned re-laparotomy made sense for ensuring source control, improvements in imaging, intensive care therapy, and percutaneous interventions may have shifted the balance toward the laparotomy-on-demand strategy. Regardless of strategy, the rate of negative laparotomy remains high (>30%). Randomized trials are not available to provide definitive evidence, and clinical judgment continues to be the basis for decision making.
Further work to develop more specific clinical tools and criteria to improve the accuracy of diagnosis may lead to use of the laparotomy-on-demand strategy rather than planned re-laparotomy. At this time, there is no good clinical evidence to support one strategy over the other from a mortality standpoint.
剖腹术在腹腔感染治疗中的作用仍存在争议。有两种策略被使用：计划性剖腹术或按需剖腹术。
对这个有争议的主题的文献进行了回顾。
尽管过去，计划性剖腹术在确保源头控制方面有意义，但影像学、重症监护治疗和经皮介入的改进可能已经将平衡转向了按需剖腹术策略。无论采用哪种策略，阴性剖腹术的发生率仍然很高（>30%）。随机试验无法提供明确的证据，临床判断仍然是决策的基础。
进一步的工作可以开发更具体的临床工具和标准来提高诊断的准确性，这可能会导致按需剖腹术策略的使用而不是计划性剖腹术。目前，从死亡率的角度来看，没有很好的临床证据支持一种策略优于另一种策略。
