第三类型腹膜炎因其定义、发生机制、病理生理和治疗方法存在争论，一直未能引起国内医生的广泛注意。此型腹膜炎多发生于免疫抑制、高龄、营养不良和慢性脏器功能障碍的病人。感染源控制措施不满意、腹腔继发感染和肠源性感染亦是发生第三类型腹膜炎的原因。致病菌多为致病力弱但多重耐药的医院常居菌如大肠杆菌、铜绿假单胞菌、肠球菌和真菌等。治疗措施包括早期损伤控制性复苏、合理的感染源控制措施、合理使用抗菌药物、尽早恢复肠内营养、免疫功能监测与调理。

Management of tertiary peritonitis Ren Jian-an Li Jie-shou. Rsearch Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command of PLA, Nanjing 210002, China Corresponding author: REN Jian-an, E-mail: jian@medmail.com.cn Abstract Through understanding of the etiology and pathology of peritonitis physiological characteristics, it can prevent the third type of peritonitis. In order to prevent the third type of peritonitis, the surgeon should diagnose and treat primary and secondary peritonitis timely, pay attention to the source of infection and control operation as well as the rational use of drugs. To strengthen the monitoring and regulating immune function, and carry out enteral nutrition support actively, including timely and rational operation and drainage is most important.