CAJ | 학술논문

目的：探讨腹部创伤后严重腹腔感染的原因及救治经验。方法回顾性分析我院2006年2月～2013年5月间收治的37例腹部创伤后严重腹腔感染的临床资料，男性31例，女性6例；年龄17～73岁，平均37．25岁。分析损伤部位、致伤原因、腹腔感染原因、治疗方法和并发症情况。结果本组37例病例经体格检查、腹腔穿刺、超声或CT等确诊。腹腔感染主要原因：剖腹探查漏诊13例，手术方式不当9例，胃肠延迟破裂7例。分别行胃肠修补或吻合7例，膈下引流8例次，脓肿穿刺置管引流5例次，结肠单腔造口4例，坏死肝组织清除和胆囊切除各1例，负压封闭引流2例。35例腹腔液作药物敏感鉴定，全部病例使用抗生素。并发脓毒性休克17例。死亡1例（2.7％），死于严重腹腔感染后多器官功能障碍综合征（ MODS），其余痊愈出院。结论漏诊胃肠道损伤、手术方式不当及胃肠延迟破裂是腹部创伤后严重腹腔感染的主要原因；外科手术控制感染源和早期合理使用抗生素是治疗严重腹腔感染的关键。
목적：탐토복부창상후엄중복강감염적원인급구치경험。방법회고성분석아원2006년2월～2013년5월간수치적37례복부창상후엄중복강감염적림상자료，남성31례，녀성6례；년령17～73세，평균37．25세。분석손상부위、치상원인、복강감염원인、치료방법화병발증정황。결과본조37례병례경체격검사、복강천자、초성혹CT등학진。복강감염주요원인：부복탐사루진13례，수술방식불당9례，위장연지파렬7례。분별행위장수보혹문합7례，격하인류8례차，농종천자치관인류5례차，결장단강조구4례，배사간조직청제화담낭절제각1례，부압봉폐인류2례。35례복강액작약물민감감정，전부병례사용항생소。병발농독성휴극17례。사망1례（2.7％），사우엄중복강감염후다기관공능장애종합정（ MODS），기여전유출원。결론루진위장도손상、수술방식불당급위장연지파렬시복부창상후엄중복강감염적주요원인；외과수술공제감염원화조기합리사용항생소시치료엄중복강감염적관건。
Objective To investigate the cause and therapy of severe intra-abdominal infection following abdominal injuries .Methods The clinical data of 37 cases of severe abdominal infection following abdominal inju-ries in our hospital from Feb .2006 to May 2013 were studied retrospectively .There were 31 males and 6 females, with mean age of 37.25 years old (ranged from 17 to 73 years old).The injury site,causes,abdominal infection causes,treatment methods and complications were analyzed .Results For all of the patients,the intra-abdominal infection was diagnosed by physical examination ,abdominal paracentesis ,ultrasound and CT scan .The causes of in-fection included miss-diagnosis in 13 cases during initial exploratory laparotomy ,inappropriate primary surgical treat-ment in 9 cases,delayed rupture after gastrointestinal contusion in 7 cases.Gastrointestinal repair or resection was performed in 7 cases,subphrenic drainage in 8 cases,percutaneous puncture and catheter drainage of intra-abdominal abscess in 5 cases,proximal colostomy and closure of distal end in 4 cases,debridement of necrosed hepatic tissue and cholecystotomy in 1 case,and vacuum sealing drainage in 2 cases.Bacteriological culture and examinations of abdominal fluid were performed and antibiotics was given in all the 35 cases.Seventeen cases were associated with septic shock and 1 case(2.7%)died of MODS due to severe intra-abdominal infection.The remaining cases were cured.Conclusion Miss-diagnosis of intestinal injury ,inappropriate primary surgical treatment and delayed rup-ture following gastrointestinal contusion are main causes of severe intra-abdominal infection in abdominal injuries . Operative control of infectious source and early rational use of antibiotics are the key elements to treat severe intra -abdominal infection .