Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Jie , WEN Zhang , ZHANG Lian , XU Banghao ,  GUO Ya

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, P.R.China;

Corresponding?author：

GUO Ya, Email: guoya2000@medmail.com.cn

Keywords：

severe intra-abdominal infection; ultrasound; abdominal cavity puncture; drainage; surgical operation; multidisciplinary

DOI：

10.7507/1007-9424.201606071

Video：

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Objective To summarize experience and efficacy of multidisciplinary treatment for severe intra-abdominal infection. Methods The clinical data of 17 patients with severe intra-abdominal infection underwent multidisciplinary treatment were analyzed retrospectively. There were 5 cases of severe acute pancreatitis, 4 cases of postoperative biliary fistula, 2 cases of intestinal fistula, 2 cases of pancreatic trauma, 1 case after resection for intestinal necrosis, 1 case of abdominal trauma, 1 case after operation for liver abscess, 1 case of unexplained severe intra-abdominal infection. The experiences of multidisciplinary treatment including the intensive care unit (ICU), surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on were summarized. Results After multidisciplinary treatment, 13 patients were cured, of which 4 patients treated by non-open operation. Three patients died, including 1 patient died of infectious shock, 1 patient died of pancreatic bed bleeding, 1 patient died of multiple organ failure. There was 1 case of automatic discharge. Conclusions Multidisciplinary treatment including ICU, surgery, blood purification center, and departments of pharmacy, nutrition, and digestion and internal medicine, and so on has an exact clinical curative effect in patients with severe intra-abdominal infection. Concept of damage control should be followed by surgical intervention. Abdominal cavity puncture and drainage has some advantages of small trauma and good clinical effect, which is suitable for infection control of patients with severe intra-abdominal infection, it could provide surgical condition and opportunity for patients required further surgical treatment.

Citation： WEIJie, WENZhang, ZHANGLian, XUBanghao, GUOYa. Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 190-194. doi: 10.7507/1007-9424.201606071 Copy

1.	?任建安, 黎介壽. 嚴重腹腔感染的綜合治療. 中國實用外科雜志, 2007, 27(12): 940-942.
2.	王紅旭, 付月云, 陳志權, 等. 腹部外科危急重癥的損傷控制性外科治療. 中國醫學工程, 2015, 23(11): 171.
3.	郭佐銘, 孫備, 白雪巍, 等. 經皮穿刺置管引流在重癥急性胰腺炎繼發腹腔感染中的應用. 腹部外科, 2013, 26(3): 158-160.
4.	伊敏, 么改琦, 白宇. 腹腔內壓監測在危重患者中的臨床應用. 中華危重病急救醫學, 2014, 26(3): 175-178.
5.	江明萬, 于雙, 王晴雷. 置管引流應用于重癥急性胰腺炎繼發腹腔感染的臨床研究. 中華醫院感染學雜志, 2015, 25(5): 1119-1121.
6.	馬炳強, 趙允召, 趙坤, 等. 膿毒癥時腸道細菌易位發生部位的研究. 腸外與腸內營養, 2010, 17(3): 156-159.
7.	雷衍軍, 王湘英, 肖彥, 等. 床旁超聲引導經皮腹腔穿刺置管引流治療重癥急性胰腺炎. 中國普通外科雜志, 2013, 22(9): 1216-1219.
8.	呂少誠, 史憲杰, 梁雨榮, 等. 肝臟及膽管術后膽瘺合并腹腔感染的診療分析. 中華保健醫學雜志, 2012, 14(5): 348-350.
9.	Wondberg D, Larusson HJ, Metzger U,et al. Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg, 2008, 32(12): 2724-2729.
10.	Solomkin JS, Mazuski JE, Bradley JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(2): 133-164.
11.	楊帆, 趙允召, 陳鈺, 等. 血液濾過治療對嚴重腹腔感染病人血漿內毒素及細胞因子的影響. 腸外與腸內營養, 2013, 20(3): 151-153, 156.
12.	Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
13.	Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg, 2002, 137(7): 845-849.
14.	Cheadle WG, Spain DA. The continuing challenge of intra-abdominal infection. Am J Surg, 2003, 186(5A): 15S-34S.
15.	Babu RY, Gupta R, Kang M,et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg, 2013, 257(4): 737-750.
16.	van Santvoort HC, Besselink MG, Bakker OJ,et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
17.	Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
18.	Xue P, Deng LH, Zhang ZD,et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
19.	Sturkenboom MC, Goettsch WG, Picelli G,et al. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol, 2005, 60(4): 438-443.
20.	吳濤, 劉玉村. 2010 年版 IDSA 復雜腹腔感染診治指南解讀. 中華醫學信息導報, 2010, 25(24): 14-16.
21.	樓征, 黎介壽, 任建安, 等. 腹腔感染及腹腔高壓影響腸蠕動功能的實驗研究. 腸外與腸內營養, 2007, 14(6): 326-329.
22.	Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66(1): 16-24.
23.	徐紅梅. 經鼻空腸管行早期腸內營養支持應用于嚴重腹腔感染術后患者的效果評價. 中國實用護理雜志, 2012, 28(24): 48-49.
24.	李幼生. 損傷控制性外科時代嚴重創傷病人的營養支持. 腸外與腸內營養, 2016, 23(1): 4-7.
25.	宋飛翔, 崔玉梅, 韓春紅, 等. 早期腸內營養對胃癌患者術后腸功能的影響評價. 中國醫藥導刊, 2011, 13(7): 1247-1252.
26.	陳健, 王磊, 李炳慶, 等. 腸內營養支持治療對急性重癥胰腺炎腸黏膜屏障功能及細菌移位的影響. 中國老年學雜志, 2014, 34(12): 3325-3326.

1. ?任建安, 黎介壽. 嚴重腹腔感染的綜合治療. 中國實用外科雜志, 2007, 27(12): 940-942.
2. 王紅旭, 付月云, 陳志權, 等. 腹部外科危急重癥的損傷控制性外科治療. 中國醫學工程, 2015, 23(11): 171.
3. 郭佐銘, 孫備, 白雪巍, 等. 經皮穿刺置管引流在重癥急性胰腺炎繼發腹腔感染中的應用. 腹部外科, 2013, 26(3): 158-160.
4. 伊敏, 么改琦, 白宇. 腹腔內壓監測在危重患者中的臨床應用. 中華危重病急救醫學, 2014, 26(3): 175-178.
5. 江明萬, 于雙, 王晴雷. 置管引流應用于重癥急性胰腺炎繼發腹腔感染的臨床研究. 中華醫院感染學雜志, 2015, 25(5): 1119-1121.
6. 馬炳強, 趙允召, 趙坤, 等. 膿毒癥時腸道細菌易位發生部位的研究. 腸外與腸內營養, 2010, 17(3): 156-159.
7. 雷衍軍, 王湘英, 肖彥, 等. 床旁超聲引導經皮腹腔穿刺置管引流治療重癥急性胰腺炎. 中國普通外科雜志, 2013, 22(9): 1216-1219.
8. 呂少誠, 史憲杰, 梁雨榮, 等. 肝臟及膽管術后膽瘺合并腹腔感染的診療分析. 中華保健醫學雜志, 2012, 14(5): 348-350.
9. Wondberg D, Larusson HJ, Metzger U,et al. Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis: low primary closure rate. World J Surg, 2008, 32(12): 2724-2729.
10. Solomkin JS, Mazuski JE, Bradley JS,et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis, 2010, 50(2): 133-164.
11. 楊帆, 趙允召, 陳鈺, 等. 血液濾過治療對嚴重腹腔感染病人血漿內毒素及細胞因子的影響. 腸外與腸內營養, 2013, 20(3): 151-153, 156.
12. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
13. Cinat ME, Wilson SE, Din AM. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. Arch Surg, 2002, 137(7): 845-849.
14. Cheadle WG, Spain DA. The continuing challenge of intra-abdominal infection. Am J Surg, 2003, 186(5A): 15S-34S.
15. Babu RY, Gupta R, Kang M,et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg, 2013, 257(4): 737-750.
16. van Santvoort HC, Besselink MG, Bakker OJ,et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
17. Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol, 2006, 101(10): 2379-2400.
18. Xue P, Deng LH, Zhang ZD,et al. Infectious complications in patients with severe acute pancreatitis. Dig Dis Sci, 2009, 54(12): 2748-2753.
19. Sturkenboom MC, Goettsch WG, Picelli G,et al. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol, 2005, 60(4): 438-443.
20. 吳濤, 劉玉村. 2010 年版 IDSA 復雜腹腔感染診治指南解讀. 中華醫學信息導報, 2010, 25(24): 14-16.
21. 樓征, 黎介壽, 任建安, 等. 腹腔感染及腹腔高壓影響腸蠕動功能的實驗研究. 腸外與腸內營養, 2007, 14(6): 326-329.
22. Powell-Tuck J. Nutritional interventions in critical illness. Proc Nutr Soc, 2007, 66(1): 16-24.
23. 徐紅梅. 經鼻空腸管行早期腸內營養支持應用于嚴重腹腔感染術后患者的效果評價. 中國實用護理雜志, 2012, 28(24): 48-49.
24. 李幼生. 損傷控制性外科時代嚴重創傷病人的營養支持. 腸外與腸內營養, 2016, 23(1): 4-7.
25. 宋飛翔, 崔玉梅, 韓春紅, 等. 早期腸內營養對胃癌患者術后腸功能的影響評價. 中國醫藥導刊, 2011, 13(7): 1247-1252.
26. 陳健, 王磊, 李炳慶, 等. 腸內營養支持治療對急性重癥胰腺炎腸黏膜屏障功能及細菌移位的影響. 中國老年學雜志, 2014, 34(12): 3325-3326.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multidisciplinary treatment of patients with severe intra-abdominal infection (report of 17 cases)

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