Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Faculdade de Medicina, Universidade Federal do Vale do São Francisco, Petrolina, PE, BR.
Clinics (Sao Paulo). 2019;74:e937. doi: 10.6061/clinics/2019/e937. Epub 2019 Jul 10.
Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy.
Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT.
Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces.
Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.
尽管弥漫性腹膜炎治疗方案有所进展，但仍有部分病例治疗效果不佳。随着负压治疗技术的出现，剖腹术治疗腹膜炎的应用得到了关注。另一种治疗方法是持续腹腔灌洗。然而，这种技术的维持较为困难，并且其结果存在争议。我们提出了一种新的持续腹腔灌洗模型，该模型利用了负压剖腹术的特点和优势。
在全身麻醉下对猪（长白猪和大白猪）进行剖腹术，在每侧腹壁放置一个多孔管，并将其引出至左下方和右下象限。应用负压敷料，并维持间歇性负压。然后通过管道持续输注腹膜透析液（PDS）36 小时。评估间歇性输注液体时的腹膜造口稳定性、系统对阻塞和渗漏的阻力、水平衡、血流动力学和生化参数。通过 CT 分析腹腔内液体分布情况。
即使未施加负压，敷料仍能保持系统的完整性，在整个过程中，导管无泄漏或堵塞。负压剖腹术抽吸的体积与输注的体积相似（9073.5±1496.35ml 与 10165±235.73ml，p=0.25），且血流动力学和生化分析无明显变化。根据 CT 图像，60ml/kg 的 PDS 足以占据所有腹腔空间。
带负压的持续腹腔灌洗在技术上是可行的，可能是弥漫性腹膜炎治疗的一种选择。
