关键词: 复杂腹腔感染, 升阶梯治疗, 微创引流, 微创手术, 开放手术, 腹腔开放

Abstract:

Escalation surgical therapy approaches for complicated intra-abdominal infection        LI You-sheng*, LI Jie-shou. *Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011,China
Correspondingauthor：LI Jie-shou，E-mail：lijieshounj@163.com
Abstract    Complicated intra-abdominal infections（cIAIs） is always associated with high mortality，invasive open surgery cannot improve patients’prognosis.With the spread of the concept of minimally invasive surgery （MIS） and damage control surgery （DCS），the authors propose the escalation surgical therapy approaches to better manage cIAIs with less operative damange.These approaches include minimally invasive drainage（percutaneous drainage，endoscopic drainage），MIS （minimally invasive operative drainage，enterostomy） and open surgery （relaparotomy on demand，planned relaparotomy，open abdomen）.These treatments cause increasing trauma stress，longer recovery period and higher morbidity rates to patients successively.Due to the increased use of planned relaparotomy in treating cIAIs，abdominal packing and open abdomen were applied more frequently.However，the prevention of open abdomen-associated morbidies，including enterocutaneous fistula and abdominal wall defect，should be paid attention to.In clinical practice，use of escalation surgical therapy approaches to treat cIAIs is not fixed，doctors should choose appropriate management according to patients’conditions.Meanwhile，good resuscitation，appropriate choice of antibiotics and nutritional support are essential to improve the outcome of patients with cIAIs.

Key words: complicated intra-abdominal infections, escalation surgical therapy, minimally invasive drainage, minimally invasive surgery, open surgery, open abdomen