Couinaud C
J Chir (Paris). 1979 Aug-Sep;116(8-9):481-5.
28 patients were operated on for subphrenic abscess, one patient died. The author emphasises the disadvantages of excessive antibiotics. The diagnosis should be made early in order to avoid severe infective complications. The diagnosis is not difficult. It is nowadays facilitated by echotomography and scannography, which permit one to localise precisely the collection of pus and to detect multiple abscesses. The incision should carefully avoid crossing the peritoneal or pleural cavities. The quality and the permanence of the drainage are the key to success. One should therefore leave in position numerous aspiration drains. One should generally abstain from any suture or digestive anastomosis. It is sufficient to direct the digestive fistula, when present, towards the skin surface. But the best policy is to avoid this operative complication the origin of which is almost always a mistake in the design or installation of the drain at the end of various operations on the abdomen.
28例患者接受了膈下脓肿手术,1例死亡。作者强调了过度使用抗生素的弊端。应尽早做出诊断,以避免严重的感染并发症。诊断并不困难。如今,超声断层扫描和扫描术有助于诊断,它们能精确地定位脓液聚集部位并检测出多个脓肿。切口应小心避免穿过腹膜腔或胸膜腔。引流的质量和持续性是成功的关键。因此,应留置多个穿刺引流管。一般应避免任何缝合或消化道吻合术。如有消化道瘘,将其引向皮肤表面即可。但最佳策略是避免这种手术并发症,其根源几乎总是在腹部各种手术结束时引流管设计或放置有误。