Andrus C, Doering M, Herrmann V M, Kaminski D L
Am J Surg. 1986 Dec;152(6):682-6. doi: 10.1016/0002-9610(86)90448-4.
Intraabdominal infection remains a common cause of death in surgical patients. Progress in this area with improved survival rates is difficult to demonstrate despite the use of antibiotics, nutritional support, and aggressive maintenance of function of failed organs. This report documents our experience with planned reoperation to cleanse the abdominal cavity in 77 patients with generalized intraabdominal infection. In 34 of the patients, reoperation to cleanse the abdominal cavity was performed every 24 to 48 hours after the first operation until the abdominal cavity was judged to be clean. Forty-three patients underwent a single operation for intraabdominal contamination and were treated expectantly, only undergoing reoperation for signs of recurrent infection. In all patients, the hole in the intestinal tract was controlled primarily by stoma formation at the initial operation to treat intraabdominal infection. Patients with appendiceal disease were excluded. The severity of illness in the two patient groups was compared by a modified acute physiologic score. Planned reoperation was not associated with improvement in survival when compared with patients managed expectantly. Patients managed by planned reoperation had significantly more laparotomies than patients managed expectantly without improving survival. The results of this study disclosed that empiric reoperation to clean the abdominal cavity in patients with generalized intraabdominal infection produced no improvement in survival when compared with observation and reoperation when indicated.
腹腔内感染仍然是外科患者常见的死亡原因。尽管使用了抗生素、营养支持以及积极维持功能衰竭器官的功能，但该领域在提高生存率方面的进展仍难以体现。本报告记录了我们对77例弥漫性腹腔内感染患者进行计划性再次手术以清洁腹腔的经验。在34例患者中，首次手术后每24至48小时进行一次清洁腹腔的再次手术，直至腹腔被判定清洁。43例患者因腹腔污染接受了单次手术，并采用观察等待的方式，仅在出现反复感染迹象时才进行再次手术。在所有患者中，肠道穿孔在初次手术治疗腹腔内感染时主要通过造口形成来控制。患有阑尾疾病的患者被排除在外。通过改良急性生理评分比较两组患者的疾病严重程度。与观察等待治疗的患者相比，计划性再次手术与生存率的改善无关。计划性再次手术治疗的患者比观察等待治疗的患者接受剖腹手术的次数显著更多，但生存率并未提高。本研究结果表明，与观察等待并在必要时进行再次手术相比，对弥漫性腹腔内感染患者进行经验性再次手术以清洁腹腔并不能提高生存率。
