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

摘要：

复杂腹腔感染（cIAIs）的病死率居高不下，侵袭性开放手术并不能改善cIAIs的预后。随着微创手术和损伤控制外科（DCS）理念的推广，学界提出了外科升阶梯治疗的理念，以期尽可能以最小的手术创伤达到最佳的治疗效果。外科升阶梯治疗包括：微创引流（经皮穿刺引流、内镜下引流），微创手术（微创手术引流、肠造口）和开放手术（按需再开腹、计划性再开腹、腹腔开放），这些治疗方法对病人的创伤应激依次增大，术后的恢复时间不断延长，手术并发症发生率也逐渐增高。由于计划性再开腹手术在cIAIs治疗中的应用愈来愈多，腹腔填塞与开放的使用也不断增多，应重视腹腔开放并发症的预防与治疗，包括肠空气瘘、腹壁缺损等。在临床实际应用中，cIAIs的升阶梯治疗并非一成不变，需要依据病人的实际情况选择合适的治疗方案。同时，良好的复苏、抗生素的合理选择以及营养支持对cIAIs的外科治疗效果也至关重要。

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