Sugimoto K, Hirata M, Kikuno T, Takishima T, Maekawa K, Ohwada T
Department of Traumatology and Critical Care Medicine, Kitasato University, School of Medicine, Kanagawa, Japan.
J Trauma. 1995 Oct;39(4):689-92. doi: 10.1097/00005373-199510000-00013.
The benefits of large-volume intraoperative peritoneal lavage (IOPL), with an assistant lavage device, were evaluated retrospectively in 114 patients with peritonitis caused by blunt traumatic rupture of the small bowel. Postoperative complications caused by infection were a major problem after rupture of the small bowel (46 of 114, 39.4%). Both prolongation of the interval between injury and laparotomy and rupture of the lower part of the small bowel were risk factors for postoperative complications caused by infection. Large-volume IOPL (25.2 +/- 2.1 L) with an assistant lavage device reduced the rate of complications caused by infection from 30 of 58 (51.8%) to 15 of 56 (26.8%). The volume used for IOPL was closely related to the occurrence of postoperative complications resulting from infection. No complications from infection occurred in patients who received lavage with of 28.3 +/- 2.7 L of saline, whereas complications occurred in those patients treated with a smaller volume of lavage fluid (18.0 +/- 2.5 L). Large-volume IOPL should be considered in patients with blunt rupture of the small bowel who are at risk for infection, and the assistant device for IOPL may be useful for such treatment.
我们对114例因钝性创伤导致小肠破裂引起腹膜炎的患者进行回顾性分析，评估使用辅助灌洗装置进行大容量术中腹腔灌洗（IOPL）的益处。小肠破裂后，感染引起的术后并发症是一个主要问题（114例中有46例，占39.4%）。受伤至剖腹手术间隔时间延长以及小肠下段破裂都是感染引起术后并发症的危险因素。使用辅助灌洗装置进行大容量IOPL（25.2±2.1升）可使感染引起的并发症发生率从58例中的30例（51.8%）降至56例中的15例（26.8%）。IOPL使用的液体量与感染引起的术后并发症的发生密切相关。接受28.3±2.7升生理盐水灌洗的患者未发生感染相关并发症，而使用较少量灌洗液体（18.0±2.5升）治疗的患者则出现了并发症。对于有感染风险的钝性小肠破裂患者，应考虑进行大容量IOPL，且IOPL辅助装置可能有助于此类治疗。
