Deck K B, Berne T V
Arch Surg. 1979 Oct;114(10):1165-8. doi: 10.1001/archsurg.1979.01370340071012.
Although extraserous drainage of subphrenic abscesses has gained wide acceptance, there is some renewed enthusiasm for the more frequent use of a transperitoneal operation because it affords the opportunity to discover unsuspected pathologic conditions, particularly heterotopic abscess. In 44 patients with postoperative subphrenic abscesses, the approach to drainage was selected on the basis of the clinical circumstances. Among 28 patients whose abscesses were drained extraserously, the incidence of heteroptic and recurrent abscesses was low. No serious complications of peritoneal or wound soilage occurred after transperitoneal drainage in 16 patients, yet the problems of inadequate drainage and heteroptic abscess were not eliminated. Celiotomy prior to definitive abscess localization was required for 13 patients. Five patients died. The operative approach should be based on the clinical assessment of the patient and particularly on the probability that multicentric intra-abdominal pathologic conditions exist.
尽管膈下脓肿的浆膜外引流已被广泛接受，但人们对更频繁地使用经腹手术重新产生了兴趣，因为这种手术有机会发现未被怀疑的病理状况，尤其是异位脓肿。在44例术后膈下脓肿患者中，根据临床情况选择引流方法。在28例经浆膜外引流脓肿的患者中，异位和复发性脓肿的发生率较低。16例经腹引流患者术后未发生严重的腹膜或伤口污染并发症，但引流不充分和异位脓肿的问题并未消除。13例患者在明确脓肿定位之前需要进行剖腹手术。5例患者死亡。手术方式应基于对患者的临床评估，特别是基于存在多中心腹腔内病理状况的可能性。
