Wang S M, Wilson S E
Arch Surg. 1977 Aug;112(8):934-6. doi: 10.1001/archsurg.1977.01370080032004.
Recent changes in the etiology, topography, and bacteriology of subphrenic abscess are identified in 93 patients treated between 1955 and 1975. Gastric and biliary tract operation account for 52% of abscesses. Appendicitis is now responsible for only 8% of subphrenic infections, in contrast with the 40% of previous reports. Colonic surgery (19%) and trauma (8%) are increasing in importance. Left-sided abscesses occur in 40%, and multiple space abscesses in 20% of patients. The bacterial flora consists of multiple strains of aerobic and anaerobic organisms. Since 1970, the aerobes have been Escherichia coli (96%), Klebsiella (21%), and Proteus (38%); anaerobes include Bacteroides (83%), cocci (50%), and clostridia (50%). The mean interval from the preceding operation until drainage of the subphrenic abscess was 5.5 weeks. Overall mortality was 31%, with higher mortalities for multiple space involvement (39%) and for abscesses developing after emergency procedures (35%). Recommendations based on this data are: (1) antibiotics selected should be effective against anaerobes, and (2) transperitoneal drainage is frequently indicated because of the increase in multiple abscesses and the need to evaluate the first operation.
对1955年至1975年间接受治疗的93例患者进行分析，确定了膈下脓肿在病因、部位及细菌学方面的近期变化。胃和胆道手术导致的脓肿占52%。阑尾炎导致的膈下感染目前仅占8%，而之前的报告中这一比例为40%。结肠手术（19%）和外伤（8%）导致膈下脓肿的比例在增加。40%的患者发生左侧脓肿，20%的患者出现多间隙脓肿。细菌菌群包括多种需氧菌和厌氧菌。自1970年以来，需氧菌为大肠杆菌（96%）、克雷伯菌（21%）和变形杆菌（38%）；厌氧菌包括拟杆菌（83%）、球菌（50%）和梭状芽孢杆菌（50%）。从上次手术至膈下脓肿引流的平均间隔时间为5.5周。总体死亡率为31%，多间隙受累（39%）及急诊手术后发生的脓肿（35%）死亡率更高。基于这些数据给出的建议是：（1）选用的抗生素应能有效对抗厌氧菌；（2）由于多间隙脓肿增多且需要评估首次手术情况，经腹引流经常是必要的。
