CAJ | 학술논문

目的探讨腹腔开放疗法治疗严重腹腔感染的临床疗效.方法回顾性分析2009年1月至2014年1月兰州军区兰州总医院收治的36例严重腹腔感染患者的临床资料.所有患者完善检查后,行早期复苏,遵循“损伤控制外科”原则开腹清创,一期手术行腹腔开放疗法,腹腔感染控制后于14 d内行二期关闭腹腔术.术中吸取腹腔内脓液行细菌培养.术后予以抗休克、抗感染、保护脏器功能、营养支持和对症治疗.采用门诊和电话方式进行随访,随访时间截至2014年3月.结果所有患者顺利完成一期和二期手术,二期术后因感染性休克和MODS死亡6例,治愈出院30例,其中行2次手术8例.两期手术时间为(157±26) min,术中出血量为(230±64) mL,术后胃肠功能恢复时间为(44 ±7)h,术后住院时间为(16±5)d.所有患者成功行腹腔脓液细菌培养,共分离出菌株48株,其中革兰阴性菌31株,革兰阳性菌17株,根据药物敏感试验结果选用亚胺培南和头孢哌酮等抗生素.30例患者术后均获得随访,中位随访时间为6个月.随访期间,6例患者发生粘连性肠梗阻,2例患者发生腹壁切口疝,均经肠粘连松解术或切口疝修补术治疗后痊愈.其余22例患者无并发症发生.结论对能够耐受手术的严重腹腔感染患者,采用腹腔开放疗法早期开腹清创疗效确切.
목적 탐토복강개방요법치료엄중복강감염적림상료효.방법 회고성분석2009년1월지2014년1월란주군구란주총의원수치적36례엄중복강감염환자적림상자료.소유환자완선검사후,행조기복소,준순“손상공제외과”원칙개복청창,일기수술행복강개방요법,복강감염공제후우14 d내행이기관폐복강술.술중흡취복강내농액행세균배양.술후여이항휴극、항감염、보호장기공능、영양지지화대증치료.채용문진화전화방식진행수방,수방시간절지2014년3월.결과 소유환자순리완성일기화이기수술,이기술후인감염성휴극화MODS사망6례,치유출원30례,기중행2차수술8례.량기수술시간위(157±26) min,술중출혈량위(230±64) mL,술후위장공능회복시간위(44 ±7)h,술후주원시간위(16±5)d.소유환자성공행복강농액세균배양,공분리출균주48주,기중혁란음성균31주,혁란양성균17주,근거약물민감시험결과선용아알배남화두포고동등항생소.30례환자술후균획득수방,중위수방시간위6개월.수방기간,6례환자발생점련성장경조,2례환자발생복벽절구산,균경장점련송해술혹절구산수보술치료후전유.기여22례환자무병발증발생.결론 대능구내수수술적엄중복강감염환자,채용복강개방요법조기개복청창료효학절.
Objective To investigate the clinical efficacy of open abdomen management for severe abdominal infection.Methods The clinical data of 36 patients with severe abdominal infection who were admitted to the General Hospital of Lanzhou Military Command from January 2009 to January 2014 were retrospectively analyzed.After examination,patients received resuscitation and debridement according to the principle of "damage control surgery".The surgery was divided into 2 stages.Open abdomen management was applied during the first stage,and 14 days later second stage surgery for abdominal closure was carried out when the abdominal infection was under control.Abdominal pus was collected during the operation for bacterial culture.Antishock,anti-infection,organ function protection,nutritional support and symptomatic treatment were applied after the operation.Patients were followed up via phone call and out-patient examination till March 2014.Results All the patients successfully received the first and the second stage surgeries.Six patients died of septic shock and multi-organ dysfunction syndrome,and 30 patients were cured.Eight patients underwent operation for 2 times.The operation time,volume of intraoperative blood loss,time for gastrointestinal function recovery,duration of postoperative hospital stay were (157 ±26) minutes,(230 ±64)mL,(44 ± 7) hours and (16 ± 5) days,respectively.Forty-eight bacterial strains were separated,including 31 gram-negative bacterial strains and 17 gram-positive bacterial strains.According to the results of drug sensitivity test,antibiotics including imipenem and cefoperazone were selected.Thirty patients were followed up with the median time of 6 months.Six patients were complicated with adhesive intestinal obstruction and 2 with incisional hernia,and they were cured after enterodialysis and hernia repair.No complications were detected in the other 22 patients.Conclusion The efficacy of open abdomen management and debridement is satisfactory for the treatment of severe abdominal infection in patients who can bear surgery.