Yasui Kohei, Ishiguro Seiji, Komatsu Shunichiro, Matsumura Tatsuki, Komaya Kenichi, Saito Takuya, Arikawa Takashi, Kaneko Kenitiro, Sano Tsuyoshi
Department of Surgery, Division of Gastroenterological Surgery, Aichi Medical University, Nagakute, Japan.
Asian J Endosc Surg. 2020 Jan;13(1):89-94. doi: 10.1111/ases.12685. Epub 2019 Jan 22.
The primary concern with laparoscopic intraoperative peritoneal lavage (IOPL) for generalized peritonitis relates to the difficulty and uncertainty in ensuring adequate washout of contaminated fluid. Here, we describe a new method of laparoscopy-assisted IOPL.
We performed emergency surgery in 10 patients with generalized peritonitis necessitating IOPL. A small wound retractor was inserted into the abdominal cavity through an incision and elevated to raise the abdominal wall. More than 3-L saline was injected via the retractor at one time. The abdomen was manually shaken by pressure from outside the body. Contaminated fluid was removed with a long suction device through the retractor. This procedure was repeated until the fluid was confirmed to be transparent by laparoscopy, and then drains were placed.
Median lavage time was 23.5 minutes (range, 15-34 minutes), and volume of lavage fluid was 19 L (range, 10-20 L). Median time to resumption of fluid intake was 3 days (range, 1-12 days), time to food intake was 6 days (range, 3-14 days), and time to first bowel movement was 5 days (range, 3-10 days). Median duration of antibiotic use was 8.5 days (range, 5-15 days). Complications were one case of antibiotic-induced rash, two cases of paralytic ileus, and one case of pelvic abscess. All patients recovered well without additional surgical intervention.
This new approach to laparoscopy-assisted IOPL was feasible for these patients with generalized peritonitis. This procedure enabled corpus lavage to be performed in a similarly short time to open surgery but with less invasiveness. Further research is needed to confirm indications and long-term outcomes.
腹腔镜术中腹腔灌洗（IOPL）治疗弥漫性腹膜炎的主要问题在于确保充分冲洗污染液体存在困难和不确定性。在此，我们描述一种腹腔镜辅助IOPL的新方法。
我们对10例需要进行IOPL的弥漫性腹膜炎患者进行了急诊手术。通过一个切口将一个小伤口牵开器插入腹腔并抬高以提起腹壁。经牵开器一次性注入超过3升生理盐水。通过体外施压手动摇晃腹部。用一个长吸引装置经牵开器吸出污染液体。重复此过程直至经腹腔镜确认液体变清，然后放置引流管。
灌洗时间中位数为23.5分钟（范围15 - 34分钟），灌洗液体量为19升（范围10 - 20升）。恢复液体摄入的时间中位数为3天（范围1 - 12天），开始进食时间为6天（范围3 - 14天），首次排便时间为5天（范围3 - 10天）。抗生素使用时间中位数为8.5天（范围5 - 15天）。并发症包括1例抗生素引起的皮疹、2例麻痹性肠梗阻和1例盆腔脓肿。所有患者均恢复良好，无需额外的手术干预。
这种腹腔镜辅助IOPL的新方法对这些弥漫性腹膜炎患者是可行的。该手术能在与开放手术相似的短时间内进行腹腔灌洗，但创伤较小。需要进一步研究以确认其适应证和长期疗效。
