Role of band ligation for secondary prophylaxis of variceal bleeding

AIM To summarize and critically examine the role of band ligation in secondary prophylaxis of variceal bleeding in patients with cirrhosis. METHODS A literature review was performed using the MEDLINE and PubM ed databases. The search terms consisted of the words "endoscopic band ligation" OR "variceal band ligation" OR "ligation" AND "secondary prophylaxis" OR "secondary prevention" AND "variceal bleeding" OR "variceal hemorrhage" AND "liver cirrhosis". The data collected from relevant meta-analyses and from the most recent randomized studies that were not included in these meta-analyses were used to evaluate the role of endoscopic band ligation in an effort to demonstrate the most recent advances in the treatment of esophageal varices. RESULTS This study included 11 meta-analyses published from 2002 to 2017 and 10 randomized trials published from 2010 to 2017 that evaluated the efficacy of band ligation in the secondary prophylaxis of variceal bleeding. Overall, the results proved that band ligation was superior to endoscopic sclerotherapy. Moreover, the use of β-blockers in combination with band ligation increased the treatment effectiveness, supporting the current recommendations for secondary prophylaxis of variceal bleeding. The use of transjugular intrahepatic portosystemic shunt was superior to combination therapy regarding rebleeding prophylaxis, with no difference in the survival rates; however, the results concerning the hepatic encephalopathy incidence were conflicting. Recent advances in the management of secondary prophylaxis of variceal bleeding have targeted a decrease in portal pressure based on the pathophysiological mechanisms of portal hypertension.CONCLUSION This review suggests that future research should be conducted to enhance current interventions and/or to develop innovative treatment options with improved clinical endpoints.

Endoscopic clipping for the secondary prophylaxis of bleeding gastric varices in a patient with cirrhosis:A case report

BACKGROUND Bleeding from gastroesophageal varices(GOV)is a serious complication in patients with liver cirrhosis,carrying a very high mortality rate.For secondary prophylaxis against initial and recurrent bleeding,endoscopic therapy is a critical intervention.Endoscopic variceal clipping for secondary prophylaxis in adult GOV has not been reported.CASE SUMMARY A 66-year-old man with cirrhosis was admitted to our hospital complaining of asthenia and hematochezia for 1 wk.His hemoglobin level and red blood cell counts were significantly decreased,and his fecal occult blood test was positive.An enhanced computed tomography of the abdomen showed GOV.The patient was diagnosed with hepatitis B cirrhosis-related GOV bleeding.A series of palliative treatments were administered,resulting in significant clinical improvement.Subsequently,an endoscopic examination revealed severe gastric fundal varices,prompting endoscopic variceal clipping.There were no further episodes of gastrointestinal bleeding.The GOV improved significantly on follow-up imaging and was confirmed as improved on endoscopy at the 5th post-operative month.CONCLUSION Our results suggest that endoscopic clipping is an inexpensive,safe,easy,effective,and tolerable method for the secondary prophylaxis of bleeding from gastric type 2 GOV.However,additional research is indicated to confirm its longterm safety and efficacy.

Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study

BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.

PEG-rhG-CSF用于中、高中性粒细胞减少性发热风险癌症患者一级预防与二级预防的药物经济学评价

目的评价聚乙二醇化重组人粒细胞集落刺激因子(PEG-rhG-CSF)用于中、高中性粒细胞减少性发热(FN)风险的癌症患者一级预防与二级预防的经济性。方法从中国全社会角度出发,采用TreeAge软件构建决策分析模型。主要状态包括一级预防、二级预防、相对剂量强度≥85%和相对剂量强度<85%。模型参数包括FN发生的风险、FN住院概率、相关癌症死亡概率、相关癌症效用值、直接医疗成本与间接医疗成本等。模型周期为21 d。研究时间范围为70年。主要结果包括总成本、抗感染成本、生命年、质量调整寿命年(QALY)和增量成本效果比。对结果进行了单因素敏感性和概率敏感性分析以评估结果的稳健性;并进行不同时间范围的情景分析。结果基线分析结果显示,与二级预防组相比,一级预防组患者多获得0.84个QALYs,并少支付39373元,节约总的抗感染成本为32311元,增量成本效果比为-46722元/QALY,一级预防组为绝对优势方案。情景分析结果显示,一级预防组与二级预防组相比,在任何研究时间范围都是绝对优势方案。当中国意愿支付阈值为257094元/QALY时,单因素和概率敏感性分析结果显示一级预防组具有成本效果的概率为100%。结论与二级预防相比,PEG-rhG-CSF用于中、高FN风险的癌症患者的一级预防是具有经济性的。

严重急性呼吸综合征患者继发下呼吸道感染的队列分析

目的 通过对严重急性呼吸综合征 (SARS)患者继发下呼吸道感染的回顾性队列分析 ,了解其规律及其有效的预防和治疗方法。方法 根据SARS患者继发感染的临床标准将SARS患者分为继发感染组和非继发感染组 ,分析继发感染的危险因素、细菌谱和预后。结果 SARS患者继发下呼吸道感染的弱危险因素是年龄和起病 住院时间 ,强危险因素是有创通气 ;糖皮质激素的使用与否、开始使用时间、日均治疗量与继发感染无关 ;继发感染的致病菌主要为铜绿假单胞菌、葡萄球菌、嗜麦芽窄食单胞菌、肺炎克雷伯菌和真菌 ;继发感染者出现严重并发症 ,以及住院时间长 ,其死亡率高。结论 SARS患者应尽早诊治 ,对于年龄大 ,尤其需有创通气的患者应警惕继发感染。抗生素的使用与医院内获得性感染的防治相似。

恶性血液病患者中侵袭性真菌病的二级预防

侵袭性真菌病在恶性血液病患者中发病率及死亡率均很高,有真菌感染病史的患者在进一步的化疗或造血干细胞移植中真菌感染复燃率高、预后差。真菌的二级预防可有效地预防真菌感染复燃。给予有效的二级预防,既往侵袭性真菌感染病史不影响化疗继续进行,也不再是异基因造血干细胞移植的绝对禁忌症。已经证明广谱抗真菌药物如伏立康唑、伊曲康唑、两性霉素B、卡泊芬净作为二级预防药物取得了很好的疗效,但在粒细胞缺乏和免疫抑制状态下预防真菌感染复燃仍然面临巨大的挑战。本文就恶性血液病患者中二级抗真菌预防的现状作一综述。

比较内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血:Meta分析

目的 通过分析比较套扎与硬化注射对食管静脉曲张出血患者的疗效,评价两者在二级预防中的价值.方法 检索Springer、Pubmed、Sinomed、CNKI、Cochrane Library,万方等数据库,用Cochrane图书馆的RevMan5.1软件进行Meta分析.结果 共纳入7项随机对照试验,结果显示,套扎治疗后再出血发生率显著低于硬化治疗（OR=0.54,95%CI：0.38～0.76,Z=3.56,P=0.000）;在降低病死率方面两者疗效相似（OR=0.79,95%CI：0.55～1.14,Z=1.27,P=0.21）;套扎组较硬化组能明显减少合并症（OR=0.22,95%CI：0.13～0.38,Z=5.51,P=0.000）;两组在消除静脉曲张方面效果等同（OR=1.46,95%CI：0.98～2.18,Z=1.88,P=0.060）.制作漏斗图分析发表偏倚,图中落点分布比较对称,表明本研究对纳入文献评价的发表偏倚较小.结论 套扎较硬化注射在食管静脉曲张出血二级预防中疗效更佳,套扎治疗在一般情况下更适合食管静脉曲张出血的二级预防.

重症急性胰腺炎继发感染及其防治:310例分析

背景:重症急性胰腺炎(SAP)病情凶险、病死率高,继发感染是导致SAP患者死亡的重要原因,但目前尚缺少SAP继发感染的大宗病例报道。目的:总结SAP继发感染的发生和防治情况。方法:回顾性分析1993年1月～2006年1月长海医院310例SAP患者的临床资料,作继发真菌/细菌感染的菌谱调查,详细记录患者的抗生素使用情况和治疗结果。结果:共96例(31.0%)SAP患者出现继发感染,平均感染发生时间为发病后21.31天±9.72天。感染菌谱中真菌87株,其中念珠菌62株(71.3%),毛霉菌17株(19.5%),酵母菌7株(8.0%),念珠菌中常见的菌种依次为白色念珠菌、光滑念珠菌和热带念珠菌。继发细菌感染的部位多位于腹腔。结论:SAP继发真菌感染以念珠菌感染为主,继发细菌感染则以革兰阴性菌感染为主。细菌感染预防性用药首选喹诺酮类加甲硝唑,如感染严重则加用第三代头孢菌素或亚胺培南。可根据培养结果选用敏感抗生素。对疑为真菌感染者应采取预防性抗真菌治疗。

伏立康唑在儿童急性白血病肺曲霉菌感染二级预防中的应用

目的:探讨伏立康唑在儿童急性白血病肺曲霉菌感染二级预防中的作用。方法:回顾性分析我院2009年2月-2012年7月住院的儿童急性白血病临床诊断侵袭性肺曲霉菌感染经伏立康唑治疗有效的患儿17例,在随后的化疗中应用伏立康唑片剂,每12 h口服1次,直至粒细胞恢复,共58例次(同一患儿在多次化疗骨髓抑制期使用),观察真菌感染情况,综合评价该药物的疗效和安全性。结果:经过伏立康唑片剂二级预防,化疗后均无真菌感染发生,无明显不良反应。结论:应用伏立康唑二级预防对儿童急性白血病临床诊断侵袭性肺曲霉菌感染有效、安全。

食管胃静脉曲张出血的治疗进展

食管胃静脉曲张出血(EGVB)是肝硬化患者常见的并发症,病情凶险,出血量大,病死率高。其治疗目标是预防EGVB首次出血、控制活动性出血和预防再出血,以降低病死率。治疗方法包括药物治疗、内镜下静脉曲张套扎、硬化治疗、组织粘合剂注射治疗、介入治疗、联合治疗以及外科手术治疗。根据内镜下的不同情况以及肝功能的分级等采取不同的治疗方法。现就EGVB治疗方法的一些新进展予以综述。

内镜套扎与硬化剂预防肝硬化食管静脉曲张再出血Meta分析

目的 比较套扎与硬化注射对食管静脉曲张出血患者的疗效,评价两者在二级预防中的价值。方法 检索Springer、Pubmed、Sinomed、CNKI、Cochrane Library,万方等数据库,用Cochrane图书馆的Rev Man5.1软件进行Meta分析。结果共纳入7项随机对照试验,结果显示,套扎治疗后再出血发生率显著低于硬化治疗（OR=0.54,95%CI：0.38~0.76,Z=3.56,P=0.000）;两者降低病死率方面相似（OR=0.79,95%CI：0.55~1.14,Z=1.27,P=0.21）;套扎组较硬化组能明显减少合并症（OR=0.22,95%CI：0.13~0.38,Z=5.51,P=0.000）;两组消除静脉曲张方面效果等同（OR=1.46,95%CI：0.98~2.18,Z=1.88,P=0.060）。漏斗图分析表明本研究对纳入文献评价的发表偏倚较小。结论 套扎较硬化注射在食管静脉曲张出血二级预防中疗效更佳。

异基因造血干细胞移植治疗有侵袭性真菌感染史的急性白血病3例并文献复习

目的:探讨有侵袭性真菌感染史的急性白血病患者进行异基因造血干细胞移植(allo-HSCT)的可行性。方法:3例急性白血病患者移植前均有真菌感染病史,2例肺部真菌感染,1例肺部及肝脾真菌感染,经抗真菌治疗病情好转后行异基因HSCT。所选供者均为HLA-A、B、DR位点全相合的同胞兄弟姐妹,使用改良BU/CY预处理方案,用MTX加CsA预防急性移植物抗宿主病,移植0 d开始使用抗真菌药预防真菌感染。结果:随访1年半,3例患者无白血病复发,1例出现肺部真菌感染,抗真菌治疗后好转。余2例真菌感染病灶均稳定。结论:通过控制真菌感染的易感因素及再次预防,有真菌感染史的急性白血病进行HSCT是可行的。

西安市6家二级医院Ⅰ类切口手术预防用药干预分析

目的分析西安市6家二级医院抗菌药物专项整治干预前后Ⅰ类切口手术预防用药情况,为基层医院Ⅰ类切口手术预防用药的合理使用提供依据。方法选择西安市6家二级医院共计3 235例Ⅰ类切口手术病例,分析其预防用药情况,结合抗菌药物整治工作所采取的干预措施,分析干预效果。结果Ⅰ类切口手术抗菌药物预防使用率从87.8%下降为34.0%,预防时机合理率上升到95.6%,预防给药疗程合理率上升到36.5%,给药品种选择合理率上升到53.3%,联合用药率下降到1.1%,预防给药完全合理率上升到22.4%,手术切口感染率未增加。结论西安市6家二级医院Ⅰ类切口手术预防用药情况得到明显改善,抗菌药物专项整治和干预对Ⅰ类切口手术起到了积极的推动作用。

Treatment of portal hypertension

Portal hypertension is the main complication of cirrhosis and is defined as an hepatic venous pressure gradient （HVPG） of more than 5 mmHg. Clinically significant portal hypertension is defined as HVPG of 10 mmHg or more. Development of gastroesophageal varices and variceal hemorrhage are the most direct consequence of portal hypertension. Over the last decades significant advancements in the field have led to standard treatment options. These clinical recommendations have evolved mostly as a result of rando.mized controlled trials and consensus conferences among experts where existing evidence has been reviewed and future goals for research and practice guidelines have been pro- posed. Management of varices/variceal hemorrhage is based on the clinical stage of portal hypertension. No specific treatment has shown to prevent the formation of varices. Prevention of first variceal hemorrhage depends on the size/characteristics of varices. In patients with small varices and high risk of bleeding, nonselective β-blockers are recommended, while patients with medium/large varices can be treated with either β-blockers or esophageal band ligation. Standard ofcare for acute variceal hemorrhage consists of vasoacrive drugs, endoscopic band ligation and antibiotics prophylaxis. Transjugular intrahepatic portosystemic shunt （TIPS） is reserved for those who fail standard of care or for patients who are likely to fail （＂early TIPS＂）. Prevention of recurrent variceal hemorrhage consists of the combination of β-blockers and endoscopic band ligation.

Endoscopic treatment of esophageal varices in patients with liver cirrhosis

Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Patients with medium- or largesized varices can be treated for primary prophylaxis of variceal bleeding using two strategies: non-selective beta-blockers(NSBBs) or endoscopic variceal ligation(EVL). Both treatments are equally effective. Patients with acute variceal bleeding are critically ill patients. The available data suggest that vasoactive drugs, combined with endoscopic therapy and antibiotics, are the best treatment strategy with EVL being the endoscopic procedure of choice. In cases of uncontrolled bleeding, transjugular intrahepatic portosystemic shunt(TIPS) with polytetrafluoroethylene(PTFE)-covered stents are recommended. Approximately 60% of the patients experience rebleeding, with a mortality rate of 30%. Secondary prophylaxis should start on day six following the initial bleeding episode. The combination of NSBBs and EVL is the recommended management, whereas TIPS with PTFE-covered stents are the preferred option in patients who fail endoscopic and pharmacologic treatment. Apart from injection sclerotherapy and EVL, other endoscopic procedures, including tissue adhesives, endoloops, endoscopic clipping and argon plasma coagulation, have been used in the management of esophageal varices. However, their efficacy and safety, compared to standard endoscopic treatment, remain to be further elucidated. There are safety issues accompanying endoscopic techniques with aspiration pneumonia occurring at a rate of approximately 2.5%. In conclusion, future research is needed to improve treatment strategies, including novel endoscopic techniques with better efficacy, lower cost, and fewer adverse events.

Do statins reduce the mortality rate in stroke patients treated with systemic thrombolysis in a 5-year single-center study?

The present study investigated the association between pre-treatment with a cholesterol-lowering drug(statin) or new setting hereon and the effect on the mortality rate in patients with acute ischemic stroke who received intravenous systemic thrombolysis. During a 5-year period(starting in October 2008), 542 consecutive stroke patients who received intravenous systemic thrombolysis with recombinant tissue plasminogen activator(rt-PA) at the Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany, were included. Patients were characterized according to statins. The primary endpoint was mortality;it was assessed twice: in hospital and 3 months after discharge. The secondary outcome was the rate of symptomatic intracerebral hemorrhage. Of the 542 stroke patients examined(mean age 72 ± 13 years;51% women, mean National Institutes of Health Stroke Scale(NIHSS) score 11), 138 patients(25.5%) had been pretreated with statin, while in 190 patients(35.1%) statin therapy was initiated during their stay in hospital, whereas 193(35.6%) never received statins. Patients pre-treated with statin were older and more frequently had previous illnesses(arterial hypertension, diabetes mellitus and previous cerebral infarctions), but were comparably similarly affected by the stroke(NIHSS 11 vs. 11;P = 0.76) compared to patients who were not on statin treatment at the time of cerebral infarction. Patients pretreated with statin did not differ in 3-month mortality from those newly treated to a statin(7.6% vs. 8%;P = 0.9). Interestingly, the group of patients pretreated with statin showed a lower rate of in hospital mortality(6.6% vs. 17.0;P = 0.005) and 3-month mortality(10.7% vs. 23.7%;P = 0.005) than the group of patients who had no statin treatment at all. The same effect was seen for patients newly adjusted to a statin during the hospital stay compared to patients who did not receive statins(3-month mortality: 7.1% vs. 23.7%;P < 0.001). With a good functional outcome(mRS ≤ 2), 60% of patients were discharged, the majority(69.6%;P < 0.001) of whom received a statin at discharge. The rate of symptomatic intracerebral hemorrhages in the course of cranial computed tomography was independent of whether the patients were pretreated with a statin or not(8.8% vs. 8.7%, P = 0.96). Pre-treatment with statin as well as new adjustment could reveal positive effect on prognosis of intravenous thrombolyzed stroke patients. Further investigations are required. The study was approved by the Ethic Committee of the University of Lübeck(approval No. 4-147).

Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

BACKGROUND Bleeding esophageal varices(BEV)is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25%within six weeks of the index variceal bleed.After control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selectiveβ-blockers to prevent further bleeding and eradicate EV.AIM To assess the efficacy of endoscopic variceal ligation(EVL)in controlling acute variceal bleeding,preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices(EV)in patients who present with BEV.METHODS A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and 2018.Control of acute bleeding,variceal recurrence,rebleeding,eradication and survival were analyzed using Baveno assessment criteria.RESULTS One hundred and forty patients(100 men,40 women;mean age 50 years;range,21-84 years;Child-Pugh grade A=32;B=48;C=60)underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy sessions.One hundred and fourteen(81%)of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV,while 26(19%)patients had complicated and refractory variceal bleeding.EVL controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients(95.7%).Six patients required balloon tamponade for control and 4 other patients rebled in hospital.Overall 5-d endoscopic failure to control variceal bleeding was 7.1%(n=10)and four patients required a salvage transjugular intrahepatic portosystemic shunt.Index admission mortality was 14.2%(n=20).EV were completely eradicated in 50 of 111 patients(45%)who survived>3 mo of whom 31 recurred and 3 rebled.Sixteen(13.3%)of 120 surviving patients subsequently had 21 EV rebleeding episodes and 10 patients bled from other sources after discharge from hospital.Overall rebleeding from all sources after 2 years was 21.7%(n=26).Sixty-nine(49.3%)of the 140 patients died,mainly due to liver failure(n=46)during follow-up.Cumulative survival for the 140 patients was 71.4%at 1 year,65%at 3 years,60%at 5 years and 52.1%at 10 years.CONCLUSION EVL was highly effective in controlling the sentinel variceal bleed with an overall 5-day failure to control bleeding of 7.1%.Although repeated EVL achieved complete variceal eradication in less than half of patients with BEV,of whom 62%recurred,there was a significant reduction in subsequent rebleeding.

Hemodynamic effects of propranolol with spironolactone in patients with variceal bleeds: A randomized controlled trial

AIM: To study the hemodynamic effects of spironolactone with propranolol vs propranolol alone in the secondary prophylaxis of variceal bleeding. METHODS: Thirty-five cirrhotics with variceal bleeding randomly received propranolol (n = 17: Group A) or spironolactone plus propranolol (n = 18: Group B). Hemodynamic assessment was performed at baseline and on the eighth day. RESULTS: Spironolactone with propranolol caused a greater reduction in the hepatic venous pressure gradient than propranolol alone (26.94% vs 10.2%; P < 0.01). Fourteen out of eighteen patients on the combination treatment had a reduction in hepatic venous pressure gradient to ≤ 12 mmHg or a 20% reduction from baseline in contrast to only six out of seventeen (6/17) on propranolol alone (P < 0.05). CONCLUSION: Spironolactone with propranolol results in a better response with a greater reduction in hepatic venous pressure gradient in the secondary prophylaxis of variceal bleeding. A greater number of patients may be protected by this combination therapy than by propranolol alone. Hence, this combination may be recommended for secondary prophylaxis in patients with variceal bleeding.

循证案例:重度食管胃静脉曲张出血二级预防的治疗选择

食管胃静脉曲张出血是肝硬化的严重并发症。尽管诊断和治疗方式不断改善,静脉曲张出血的死亡率仍然较高。对于未进行适当二级预防的患者,1年内再出血的发生率及死亡率更高。根据指南进行二级预防可能存在一些问题,因此我们对1例重度食管胃静脉曲张出血的案例,就其循证医学背景下的二级预防治疗的选择进行探讨。总结该患者首次治疗失败的经验及临床研究结果,我们建议:对食管胃静脉曲张再出血的高危人群应详细评估其危险因素,包括Child分级、HVPG水平、内镜检查食管胃静脉曲张程度、CTA检查,并基于此进行危险分层。除指南推荐的TIPs治疗选择之外,对存在胃壁、食管壁外巨大血管池患者,内镜治疗不宜作为首选推荐,包括TIPs在内的其他方法应优先考虑。

继发性腹膜炎抗生素治疗104例临床分析

目的 探讨继发性腹膜炎的抗生素治疗方法。方法 对 1 0 4例继发性腹膜炎进行评分 ,4 4例评分≤ 6分者给予预防性抗生素治疗 ;6 0例≥ 7分者给予治疗性抗生素治疗。结果 预防组切口感染 4例 ,腹腔残余感染无。治疗组切口感染 8例 ,腹腔残余感染 3例。全组 1例因合并心衰死亡。结论 根据腹膜炎严重程度术后合理应用抗生素 ,避免轻症腹膜炎的不必要用药。