Andersson R, Saarela A, Tranberg K G, Bengmark S
Department of Surgery, Lund University, Sweden.
Acta Chir Scand. 1990 Oct;156(10):707-10.
A series of 138 major liver resections undertaken between 1971 and 1987 were reviewed. Intrabdominal abscesses developed in 11 (8%) patients, a mean of 23 days (range 10-42) after operation and two died (mortality 18%). Eight developed after 63 right hepatectomies, two after 24 right lobectomies, one after 34 left hepatectomies and none after left lobectomies (17). Patients who developed intra-abdominal abscesses underwent significantly longer operations (mean (SEM) 400 (48) compared with 275 (21) min) (p less than 0.05) and had significantly more bleeding during the operation (7,600 (1,750) compared with 3,200 (430), p less than 0.01) than those who did not. The amounts recovered from the abdominal drains, both before and after the diagnosis, were comparatively greater in patients with abdominal abscesses. Antibiotic prophylaxis was given to 10 of 11 patients who did and 89 of 127 patients who did not, form abscesses. We conclude that the risk of intra-abdominal abscess formation after major liver resection is increased: when a large amount of liver tissue is removed (right hepatectomy or lobectomy); when there is a lot of intraoperative bleeding; and when the operation takes a long time. Antibiotic prophylaxis did not affect the risk of abscess formation this series.
对1971年至1987年间进行的138例主要肝脏切除术进行了回顾。11例（8%）患者发生腹腔内脓肿，平均在术后23天（范围10 - 42天）出现，2例死亡（死亡率18%）。8例在63例右半肝切除术后发生，2例在24例右叶切除术后发生，1例在34例左半肝切除术后发生，左叶切除术后无发生（17）。发生腹腔内脓肿的患者手术时间明显更长（平均（标准误）400（48）分钟，而未发生者为275（21）分钟）（p < 0.05），且术中出血明显更多（7600（1750），而未发生者为3200（430），p < 0.01）。腹腔脓肿患者在诊断前后从腹腔引流管引出的量相对更多。11例发生脓肿的患者中有10例以及127例未发生脓肿的患者中有89例接受了抗生素预防。我们得出结论，主要肝脏切除术后腹腔内脓肿形成的风险增加：当切除大量肝组织时（右半肝切除术或叶切除术）；当术中出血较多时；以及当手术时间较长时。在本系列中，抗生素预防并未影响脓肿形成的风险。
