胃肠道肿瘤围手术期复杂腹腔感染的外科治疗

The Surgical Therapy of Perioperative Period of Gastrointestinal Tumor Complicated Intra-abdominal Infection

目的探讨胃肠道肿瘤围手术期复杂腹腔感染的外科治疗方法。方法对46例胃肠道肿瘤围手术期复杂腹腔感染患者的临床资料进行研究,研究组23例患者行腹腔三腔引流管冲洗引流,对照组23例患者行被动的腹腔引流,所有患者的治疗根据早期目标导向治疗(EGDT)方案指导复苏。针对围手术期cIAI感染源的处理,需要贯彻损伤控制的理念,行经皮脓肿穿刺置管引流(PAD)、置腹腔引流管冲洗引流、腹腔开放疗法等的阶梯式处理方案。围手术期cIAI早期根据病区致病菌流行特点选择经验性治疗用药,细菌培养和药敏试验结果明确后,调整抗生素。早期合理联合应用肠内肠外营养并加强免疫调控。结果外科综合治疗后两组复杂腹腔感染患者的死亡率、二次手术率、切口愈合时间、抗菌药物使用天数、术后肠粘连发生率差异无统计学意义(P均>0.05);两组患者在肠瘘愈合时间、腹腔脓肿发生率、住院天数方面差异有统计学意义(P均<0.05)。结论胃肠道肿瘤围手术期cIAI外科综合治疗原则包括积极复苏、处理感染源、应用抗菌药物治疗感染、肠内肠外营养以及免疫调控等。术后腹腔三腔引流管持续负压冲洗引流及早期肠内营养在治疗胃肠道肿瘤围手术期cIAI具优势,可明显缩短肠瘘愈合时间、降低腹腔脓肿发生率、减少住院天数。

Objective To explore the methods of the surgical therapy of perioperative period of gastrointestinal tumor complicat -ed intra-abdominal infection（cIAI）.Methods This topic researched on 46 cases clinical data of perioperative period of gastrointestinal tumor cIAI patients,the 23 cases of patients of research group with abdominal three cavity drainage pipe flushing drainage ,the 23 cases of patients of control group with passive abdominal cavity drainage .EGDT scheme has a certain guiding significance in resuscitation .For the treatment of infection source with perioperative cIAI ,the concept of damage control were needed to be carried out .The step-up approach of the PAD could be performed,abdominal drain washing drainage ,open abdomen .Empiric antimicrobial therapy should be initiated once a patient received a diagnosis of an intra-abdominal infection according to epidemiological feature ,pathogen-directed antimicrobial therapy should be followed by . The desired effect were achieved by the combined application of EN and PN and strengthened immune regulation .Results After surgical comprehensive treatment of the complicated intra-abdominal infection patients of the two groups ,there was no statistically significant difference in the mortality ,the second operation rate ,the incision healing time ,the antimicrobial drug using time and the incidence of postoperative intes-tinal adhesion（P〉0.05）.But there was statistically significant difference in the intestinal fistula healing time ,the incidence of abdominal ab-scess and the hospitalization time（P〈0.05）.Conclusion The key principles of the surgical therapy of perioperative period of gastrointesti -nal tumor cIAI contain actively resuscitation ,handling the source of infection ,the treatment of infection with antibacterial drugs ,EN and PN, immune regulation etc .The abdominal three cavity drainage pipe continuous negative pressure flushing drainage and early enteral nutrition in the treatment of perioperative period of gastrointestinal tumor complicated intra -abdominal infection could obviously reduce the intestinal fistu-la healing time ,the incidence of abdominal abscess and the hospitalization time .