Strobel O, Werner J, Büchler M W
Klinik für Allgemeine, Viszerale und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
Chirurg. 2011 Mar;82(3):242-8. doi: 10.1007/s00104-010-2015-2.
Despite significant progress the therapy of peritonitis remains challenging. With a mortality of up to 20% peritonitis is a predominant cause of death due to surgical infections. An early and efficient source control combined with effective antibiotic therapy and modern intensive care and sepsis therapy are definitive for the outcome and prognosis of secondary peritonitis. In approximately 90% of patients an effective source control can be achieved by one single operation with extensive peritoneal lavage. A reoperation is necessary in only about 10% of patients. The aggressive concepts of planned relaparotomy or open packing are associated with increased morbidity and are indicated only in rare cases. The gold standard is to attempt a definitive source control by one single operation. An operative revision should be performed only on demand. The antibiotic therapy should begin with a broadly calculated empirical therapy and should later be adapted to microbiological findings. The therapy of sepsis requires standardized and state of the art intensive care.
尽管在腹膜炎治疗方面取得了显著进展，但该疾病的治疗仍然具有挑战性。腹膜炎的死亡率高达20%，是外科感染导致死亡的主要原因。早期有效的源头控制，结合有效的抗生素治疗、现代重症监护和脓毒症治疗，对于继发性腹膜炎的结局和预后至关重要。在大约90%的患者中，通过单次广泛腹膜灌洗手术即可实现有效的源头控制。仅约10%的患者需要再次手术。计划性再次剖腹手术或开放填塞等激进理念会增加发病率，仅在极少数情况下适用。金标准是通过单次手术尝试实现确定性的源头控制。仅在必要时进行手术修正。抗生素治疗应首先采用广泛计算的经验性治疗，随后根据微生物学检查结果进行调整。脓毒症的治疗需要标准化且先进的重症监护。
