Doberneck R C, Mittelman J
Surg Gynecol Obstet. 1982 Jun;154(6):875-9.
During a ten year period, 69 patients underwent 100 operations for more than 147 intra-abdominal abscesses. The over-all mortality was 24.6 per cent and the redrainage rate, 30.4 per cent. Most often, abscesses were located in the subphrenic space and followed elective gastrointestinal surgical procedures. Most patients harbored two or more different organisms. Mortalities were low in patients less than 20 years of age having a single abscess, a short duration of fever prior to drainage and after operations on the colon and secondary operations on the appendix. Mortalities were high in patients more than 40 years of age having multiple abscesses; a prolonged duration of fever prior to drainage; multiple drainage procedures, and abscesses after gastroduodenal, hepatobiliary and pancreatic procedures. The mortality and redrainage rate were lower in patients given appropriate perioperative prophylactic antibiotics than inappropriate perioperative prophylactic antibiotics at the antecedent operations. The mortality and the redrainage rate were not related to duration of administration of appropriate prophylactic antibiotics or the number of different isolates. The choice of incision for drainage should be based upon clinical findings rather than a matter of personal preference. Prompt defervescence was a sign of successful drainage. In the present study, the prime importance of prompt drainage and the secondary role of antibiotics in the treatment of intra-abdominal abscess are confirmed.
在十年期间，69例患者因147个以上腹腔内脓肿接受了100次手术。总体死亡率为24.6%，再次引流率为30.4%。脓肿最常位于膈下间隙，且多继发于择期胃肠外科手术。大多数患者感染两种或更多不同病原体。年龄小于20岁、仅有单个脓肿、引流前发热时间短、接受结肠手术及阑尾二次手术的患者死亡率较低。年龄大于40岁、有多个脓肿、引流前发热时间长、多次引流操作以及接受胃十二指肠、肝胆和胰腺手术后出现脓肿的患者死亡率较高。与前期手术时未给予适当围手术期预防性抗生素的患者相比，给予适当围手术期预防性抗生素的患者死亡率和再次引流率更低。死亡率和再次引流率与适当预防性抗生素的使用时长或不同分离菌株的数量无关。引流切口的选择应基于临床发现而非个人偏好。迅速退热是引流成功的标志。在本研究中，证实了迅速引流在腹腔内脓肿治疗中的首要重要性以及抗生素的次要作用。
