Ivatury R R, Nallathambi M, Rao P M, Rohman M, Stahl W M
Department of Surgery, New York Medical College, Lincoln Medical Mental Health Center, Bronx, NY.
Crit Care Med. 1989 Jun;17(6):511-7. doi: 10.1097/00003246-198906000-00005.
We analyzed the results of open treatment in 30 patients with abdominal sepsis (11 patients after trauma [group 1], five patients with pancreatic abscess [group 2], and 14 patients with acute GI pathology [group 3]) uncontrolled by conventional methods as evidenced by continuing fever with leukocytosis and worsening organ functions. APACHE scores at the time of initial laparotomy and at the time of open management, respectively, were: group 1, 19.8 and 16.6; group 2, 8.4 and 12.4; and group 3, 14.2 and 15.0. Twenty-seven patients had multiple system failure. Sixteen (53%) of the 30 patients survived, 73% in group 1, 60% in group 2, and 36% in group 3. Survival correlated well with age less than 50 yr and the absence of multiple organ failure. The technique was easily performed and many of the pitfalls previously reported were not observed. In patients requiring fascial prosthesis, the absorbable polyglycol acid (Dexon) mesh was found to be superior to the nonabsorbable polypropylene. We conclude that the open technique is feasible, effective, and worthy of consideration in patients with extensive wound necrosis and uncontrolled abdominal sepsis.
我们分析了30例腹部脓毒症患者的开放治疗结果（11例创伤后患者[第1组]，5例胰腺脓肿患者[第2组]，14例急性胃肠道病变患者[第3组]），这些患者经传统方法治疗无效，表现为持续发热伴白细胞增多及器官功能恶化。初次剖腹手术时及开放处理时的急性生理与慢性健康状况评分（APACHE）分别为：第1组，19.8和16.6；第2组，8.4和12.4；第3组，14.2和15.0。27例患者出现多系统功能衰竭。30例患者中有16例（53%）存活，第1组为73%，第2组为60%，第3组为36%。生存情况与年龄小于50岁及无多器官功能衰竭密切相关。该技术操作简便，未观察到先前报道的许多缺陷。在需要使用筋膜假体的患者中，发现可吸收聚乙醇酸（德克松）网片优于不可吸收的聚丙烯网片。我们得出结论，开放技术是可行、有效的，对于有广泛伤口坏死和无法控制的腹部脓毒症患者值得考虑。
