Werner P, Faivre E, Langonnet F, Belghiti J
Service de Chirurgie Digestive, Hôpital Beaujon, Clichy.
Ann Fr Anesth Reanim. 1990;9(3):261-4. doi: 10.1016/s0750-7658(05)80183-2.
In order to assess the major clinical biological and radiological signs of an intra-abdominal abscess following digestive surgery as well as the place of automatic reoperation, this retrospective study analysed 79 patients requiring intensive therapy for such a complication since 1982. Surgery consisted in oesophagectomy (n = 38), hepatectomy or cholecystectomy (n = 12), pancreatic surgery (n = 17) and colectomy (n = 12). A postoperative abdominal abscess was recognized in 75 patients consisting in intrathoracic or intra-abdominal oesophageal fistulas (n = 31), pancreatic abscesses and fistulas (n = 17), peri- or intrahepatic abscesses (n = 11), colonic fistulas (n = 12) and acalculous cholecystitis. With regard to the intensity of symptomatology the patients have been allocated into 2 groups. In group I, including 12 patients, the infectious syndrome occurred early (3 first postoperative days), was severe and associated with positive blood cultures in 60% of cases. The patients were reoperated without previous CT-scanography. Four died postoperatively. In group II, including 67 patients, the symptomatology was more discrete. CT-scanography was highly beneficial, with discovery of an abscess in 90% of cases. In 20 patients, the abscess has been punctured and drained successfully by percutaneous route. In 6 patients with negative CT-scanography, an automatic reoperation resulted in the discovery of an abscess in 2 cases. Five out of 6 of these patients died postoperatively. It is concluded that in case of intraabdominal complication following digestive surgery: a) in case of early and severe symptomatology, a rapid reoperation is mandatory; b) CT-scanography has a high diagnostic value for abscess recognition in patients with discrete and delayed symptomatology; c) nearly one third of the abscesses can be treated successfully by percutaneous drainage; d) the value of automatic reoperations remains unsubstantiated.
为了评估消化手术后腹腔内脓肿的主要临床、生物学和放射学体征以及再次手术的时机，这项回顾性研究分析了自1982年以来79例因该并发症需要重症治疗的患者。手术包括食管切除术（n = 38）、肝切除术或胆囊切除术（n = 12）、胰腺手术（n = 17）和结肠切除术（n = 12）。75例患者被诊断为术后腹腔脓肿，包括胸内或腹腔内食管瘘（n = 31）、胰腺脓肿和瘘（n = 17）、肝周或肝内脓肿（n = 11）、结肠瘘（n = 12）和无结石性胆囊炎。根据症状的严重程度，患者被分为两组。第一组包括12例患者，感染综合征出现较早（术后前3天），病情严重，60%的病例血培养呈阳性。这些患者在未进行CT扫描的情况下接受了再次手术。4例患者术后死亡。第二组包括67例患者，症状较为隐匿。CT扫描非常有用，90%的病例发现了脓肿。20例患者经皮穿刺引流脓肿成功。6例CT扫描阴性的患者中，2例通过再次手术发现了脓肿。这6例患者中有5例术后死亡。结论是，消化手术后发生腹腔内并发症时：a）症状出现早且严重时，必须迅速进行再次手术；b）CT扫描对症状隐匿和延迟出现的患者识别脓肿具有很高的诊断价值；c）近三分之一的脓肿可通过经皮引流成功治疗；d）再次手术的价值仍未得到证实。
