Penninckx F, Kerremans R, Filez L, Ferdinande P, Schets M, Lauwers P
Department of Abdominal Surgery, UZ Gasthuisberg, Catholic University of Leuven, Belgium.
Acta Chir Belg. 1990 Sep-Oct;90(5):269-74.
Patients presenting diffuse, advanced, established peritonitis due to free perforation of the colon, in whom an adequate abdominal debridement cannot be obtained in one operative session were selected. We report results of the planned relaparotomy approach in 44 patients as compared with an historical series of 9 analogous patients treated by on demand exploratory relaparotomies. Planned relaparotomies were performed every 2 days until the abdominal cavity became macroscopically clean. This approach significantly reduced both the incidence of multiple organ failure and the mortality rate (31%) as compared with the regimen of on demand relaparotomy. The mortality rate in the planned relaparotomy group is related to the age of the patient and to the nature of peritonitis. Faecal peritonitis carries a higher mortality rate than purulent peritonitis. The mortality rates of severe postoperative peritonitis and advanced primary peritonitis were not significantly different. Surgery for severe, diffuse peritonitis has to be prompt, moderately aggressive and repeated if necessary. Therefore, planned relaparotomies have a place in the treatment of selected patients presenting diffuse, advanced, established peritonitis.
入选患者为因结肠游离穿孔导致弥漫性、晚期、已确诊腹膜炎且无法在一次手术中进行充分腹腔清创的患者。我们报告了44例计划性再次剖腹手术的结果，并与9例按需进行探索性再次剖腹手术治疗的类似患者的历史系列进行了比较。计划性再次剖腹手术每2天进行一次，直到腹腔在肉眼下清洁为止。与按需再次剖腹手术方案相比，这种方法显著降低了多器官功能衰竭的发生率和死亡率（31%）。计划性再次剖腹手术组的死亡率与患者年龄和腹膜炎性质有关。粪性腹膜炎的死亡率高于脓性腹膜炎。严重术后腹膜炎和晚期原发性腹膜炎的死亡率无显著差异。对于严重的弥漫性腹膜炎，手术必须迅速、适度积极，并在必要时重复进行。因此，计划性再次剖腹手术在治疗选定的弥漫性、晚期、已确诊腹膜炎患者中具有一席之地。
