消化道穿孔致腹腔感染的外科手术治疗

Surgical management for the perforation of digestive tract with intraabdominal infection

消化道穿孔致腹腔感染是急诊手术常见原因, 大部分情况下需行病变肠段切除, 切除后行一期吻合还是造口, 是困扰临床医生的关键。随着外科技术不断进步, 患者改善生活质量的需求增加, 一期切除吻合术成为最为理想的手术方式。但由于对术后吻合口漏的担忧, 临床实际中术后造口率仍居高不下。本文对近年来有关胃肠道穿孔致腹腔感染外科手术治疗进行综述, 就穿孔位置、病因等问题, 探讨了最佳手术方案。对并对一期吻合后吻合口漏的多种预防手段进行探讨, 包括围手术期管理、胃肠道吻合和肠道灌洗减压等技术, 以期提高肠切除术后一期吻合率, 为消化道穿孔致腹腔感染的外科手术治疗提供参考, 对改善患者生活质量、减轻医疗负担具有重要意义。

Perforation of digestive tract with intra-abdominal infection is one of the common causes of emergency surgery.After the resection with intestine,primary anastomosis or stoma remains a subject of debate.With the continuous improvement of surgical technology and the need to improve patients'quality of life,primary anastomosis is supposed to be the most ideal surgery.However,the rate of stoma is still high due to concerns about postoperative anastomotic leakage.This paper summarizes the surgical treatment of intra-abdominal infection caused by gastrointestinal perforation in recent years,and discuss the best operation plan according to the perforation location and etiology.We also discuss a variety of treatment methods for the prevention of anastomotic leakage(perioperative management,gastrointestinal anastomosis,enteric lavage decompression and other techniques)to improve the primary anastomosis,improve the quality of life of patients and reduce the medical burden.