Ivatury R R, Zubowski R, Psarras P, Nallathambi M, Rohman M, Stahl W M
Department of Surgery, New York Medical College, Bronx, New York.
J Trauma. 1988 Aug;28(8):1238-43. doi: 10.1097/00005373-198808000-00017.
We reviewed our experience with intra-abdominal abscess after penetrating abdominal trauma. Of a total of 872 laparotomies (1980-1986), 29 patients (0.7% of stab wounds and 6% of gunshot wounds) developed abscesses. Pancreatic and duodenal injuries, in the presence of concomitant colon perforation, were most frequently associated with abscess formation. Fourteen of the 29 patients had multiorgan failure (MOF), Group I, and 15 patients did not have MOF, Group II. Group I had a significantly higher Abdominal Trauma Index (ATI) and Acute Physiology and Chronic Health Evaluation (APACHE II), received greater number of perioperative transfusions and underwent a higher number of reoperations for sepsis than Group II patients. Radiologic imaging techniques were frequently inconclusive for the diagnosis and localization of intra-abdominal abscess in Group I. They were highly accurate in Group II. Fifty per cent of Group I patients died from sepsis and MOF. We conclude that the anatomic (ATI) and the physiologic (APACHE) scores are useful predictors of the potential for uncontrolled sepsis. In the presence of ongoing multiorgan failure, reoperation for sepsis is warranted on clinical grounds alone.
我们回顾了穿透性腹部创伤后发生腹腔内脓肿的经验。在总共872例剖腹手术（1980 - 1986年）中，29例患者（刺伤患者中的0.7%和枪伤患者中的6%）发生了脓肿。胰腺和十二指肠损伤伴结肠穿孔时，最常与脓肿形成相关。29例患者中，14例发生多器官功能衰竭（MOF），为I组；15例未发生MOF，为II组。I组的腹部创伤指数（ATI）和急性生理与慢性健康评估（APACHE II）显著更高，围手术期输血次数更多，因脓毒症接受再次手术的次数也比II组患者多。放射学成像技术对I组腹腔内脓肿的诊断和定位常常难以定论，而在II组中则高度准确。I组50%的患者死于脓毒症和MOF。我们得出结论，解剖学（ATI）和生理学（APACHE）评分是潜在的无法控制的脓毒症的有用预测指标。在存在持续性多器官功能衰竭的情况下，仅基于临床理由就有必要因脓毒症进行再次手术。
