门静脉高压症断流术后膈下脓肿的治疗与预防

Treatment and prevention of postoperative infra-diazoma infection in patients with portal hypertension

目的 总结膈下脓肿对门静脉高压症断流术后影响。方法 回顾性分析 1 994年 5月～ 2 0 0 2年 5月在我院行门静脉高压症断流术后并发膈下脓肿 30例病人的治疗经过。其中男 2 2例 ,女 8例 ,年龄 2 7～ 6 0岁。血吸虫肝硬化 4例 ,肝炎肝硬化 2 6例。发生时间术后 1 5～ 30d ,B型超声定位一次穿刺引流 1 1例 ,二次以上 9例。小切口开腹置管引流 5例 ,调整抗生素治愈 5例。结果 30例病人术后均高热 (39℃以上 ) ,且 1 0例并发胰腺炎及胰尾脓肿 ,8例胸腔感染 ,8例并发腹膜炎 ,5例并发应激性胃溃疡 ,3例并发肝损害加重 ,2例继发泌尿系感染 ,1 5例存在上述二种或以上并发症 ,治愈时间为 4 5～ 6 0d ,较无膈下脓肿者术后愈合时间延长 (P <0 .0 5 )。结论 综合分析膈下脓肿对断流术后影响 ,了解其发生原因 ,并预防胰漏、胃漏、创面渗血发生及时作脓肿引流 ,调整致敏抗生素治疗 。

Objective To investigate the effect of infra diazoma infection on postoperative patients with portal hypertension.Methods 350 patients with portal hypertension who had been subjected to paracardiac vascular disconnection and variceal suture ligation from May 1994 to May 2002 were studied retrospectively. Among them, 30 patients suffered from postoperative infra diazoma infection, including 22 males and 8 females with age ranging from 27 to 60 years old. Of the 30 patients with infra diazoma infection, there were 4 cases of Schistosomial cirrhosis and 26 cases of posthepatic cirrhosis; 14 cases received paracardiac vascular disconnection and 16 cases variceal suture ligation. Infra diazoma infection occurred in those patients in 2 to 15 days after operation. Eleven patients were drained once through celiocentesis localized by B ultrasound, 9 patients were drained through celiocentesis two or more times, 5 patients were drained through celiotomy incision, and the rest 5 patients accepted antibiotic treatment.Results All of those 30 patients had postoperative high fever (>39℃). Ten were complicated with postoperative pancreatitis and pancreatic cauda abscess, 8 with postoperative thoracic cavity infection, 8 with postoperative peritonitis, 5 with irritable gastric ulcer, 3 with more serious liver dysfunction and 2 with urinary tract infection. It was found that 15 cases had two or more complications mentioned above. All of the patients were cured in 45 to 60 days after operation, which were longer than the patients who didn't have postoperative infra diazoma infection ( P < 0.05 ).Conclusion Analyses the effect of infra dizoma infection for postoperative patients with portal hypertension. Understanding the cause of infra dizoma infection, preventing pancreatic fistula and gastric fistula, making drainage of abscess and using sensitive antibiotics could effectively control and prevent the occurrence of infra dizoma infection.