Hunt J L
Arch Surg. 1982 Feb;117(2):209-12. doi: 10.1001/archsurg.1982.01380260075013.
The objectives of surgery for generalized peritonitis are to eliminate the source of continual bacterial contamination and to prevent septicemia and intra-abdominal abscess formation. A prospective randomized study of three different operative approaches of treating residual peritoneal contamination was undertaken: group 1, no peritoneal irrigation (14 patients); group 2, intraoperative peritoneal irrigation (15 patients); group 3, both intraoperative and postoperative peritoneal irrigation (15 patients). The mortality in groups 1, 2, and 3 was 28.5%, 26.6%, and 33%, respectively. The overall incidence of septicemia and intra-abdominal abscesses in groups 1, 2, and 3 was 23%, 22%, and 17%, respectively. In those patients who survived, the incidence of intra-abdominal abscesses, wound infection, and septicemia was 6%, 23%, and 13%, respectively. In this series, there was no detectable difference in the mortality and infectious complications between the three treatment groups. The only clinical factors that adversely affected mortality and morbidity were peritonitis originating from the colon and age greater than 60 years. Early surgical intervention with removal of the source of peritonitis, debridement of all necrotic tissue, and drainage of abscesses remain the cornerstones of successful therapy in generalized peritonitis.
弥漫性腹膜炎的手术目的是消除持续细菌污染的来源，并预防败血症和腹腔内脓肿的形成。我们进行了一项前瞻性随机研究，比较三种不同的手术方法治疗残留腹膜污染的效果：第1组，不进行腹膜冲洗（14例患者）；第2组，术中进行腹膜冲洗（15例患者）；第3组，术中及术后均进行腹膜冲洗（15例患者）。第1、2、3组的死亡率分别为28.5%、26.6%和33%。第1、2、3组败血症和腹腔内脓肿的总体发生率分别为23%、22%和17%。在存活的患者中，腹腔内脓肿、伤口感染和败血症的发生率分别为6%、23%和13%。在该系列研究中，三个治疗组之间的死亡率和感染并发症没有可检测到的差异。唯一对死亡率和发病率有不利影响的临床因素是源于结肠的腹膜炎和年龄大于60岁。早期手术干预，包括清除腹膜炎来源、清除所有坏死组织和引流脓肿，仍然是弥漫性腹膜炎成功治疗的基石。
