Chiarugi Massimo, Panicucci Sonia, Galatioto Christian, Luciani Mirene, Mancini Rudi, Cucinotta Monica, Bagnato Chiara, Mazzillo Mariangela, Pouli Elise, Seccia Massimo
Dipartimento di Chirurgia, Università di Pisa, Nuovo Ospedale Santa Chiara, Pisa, Italia.
Ann Ital Chir. 2011 Sep-Oct;82(5):377-82.
Temporary abdominal closure with planned re-operations is a treatment method for several critical abdominal conditions. Aim of the study was to evaluate the effectiveness of laparostomy and the risk factors for survival in patients presenting with severe secondary peritonitis (SSP).
52 patients (mean age 66.5) with a SSP were analyzed. The peritonitis developed spontaneously (n=34) or complicated a recent surgical operation (n=18). 18 patients were operated on for a bowel cancer and 6 of them had a metastatic disease. Skin closure (n=21), bogota bag (n=16) and vacuum-pack (n=15) were the methods employed to achieve temporary abdominal closure for planned re-operations. The severity of the disease was calculated by using APACHE II and Mannheim Peritonitis Index (MPI) scoring systems. Survival was the main outcome measure.
Mortality was 38% (n=20). Age, sex, pathogenesis of the peritonitis, type of temporary abdominal closure, number of re-operations and occurrence of entero-atmospheric fistula did not differ significantly between survivors and nonsurvivors. APACHE II (19.6 vs. 14.3; p=. 0015) and MPI (35.5 vs. 27.8; p=. 001) scores were significantly greater in the non-survivors group. The occurrence of perforated left colon/rectum was also significantly greater among non-survivors. By multivariate analysis only MPI resulted to be a significant independent risk factor for survival (p < 0.05).
SSP is a life-threatening condition. Laparostomy may have a role in controlling the source of abdominal infection but even with this outmost invasive surgical measure, mortality still remains high. For these patients, MPI may have a role as outcome predictor.
采用计划性再次手术的临时腹部关闭术是治疗多种严重腹部疾病的一种方法。本研究的目的是评估剖腹术的有效性以及严重继发性腹膜炎（SSP）患者的生存危险因素。
分析了52例SSP患者（平均年龄66.5岁）。腹膜炎为自发性发生（n = 34）或继发于近期的外科手术（n = 18）。18例患者因结肠癌接受手术，其中6例有转移性疾病。皮肤缝合（n = 21）、波哥大袋（n = 16）和真空包装（n = 15）是用于计划性再次手术的临时腹部关闭术的方法。采用急性生理与慢性健康状况评分系统II（APACHE II）和曼海姆腹膜炎指数（MPI）评分系统计算疾病严重程度。生存是主要的观察指标。
死亡率为38%（n = 20）。幸存者和非幸存者在年龄、性别、腹膜炎的发病机制、临时腹部关闭术的类型、再次手术的次数以及肠-气瘘的发生情况方面无显著差异。非幸存者组的APACHE II评分（19.6对14.3；p = 0.0015）和MPI评分（35.5对27.8；p = 0.001）显著更高。非幸存者中穿孔性左结肠/直肠的发生率也显著更高。多因素分析显示，只有MPI是生存的显著独立危险因素（p < 0.05）。
SSP是一种危及生命的疾病。剖腹术可能在控制腹部感染源方面发挥作用，但即使采用这种最具侵入性的外科措施，死亡率仍然很高。对于这些患者，MPI可能作为预后预测指标。
