[Laparoscopic surgery for advanced peritonitis].

Q4 Medicine

Khirurgiya Pub Date : 2024-01-01 DOI:10.17116/hirurgia202410121

N V Lebedev, A E Klimov, V S Popov, I O Abuladze, A A Barkhudarov

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引用次数: 0

Abstract

Objective: To determine the criteria for choosing surgical access in patients with advanced peritonitis considering its local and general manifestations.

Material and methods: We analyzed treatment outcomes in 588 patients with advanced peritonitis. The most common causes of peritonitis were destructive forms of acute appendicitis (273 cases), perforated gastroduodenal ulcers (165 cases), acute cholecystitis (59 cases). To determine the criteria for choosing surgical access in advanced peritonitis, we analyzed treatment outcomes considering MPI, SPP and WSES SSS score.

Results: The choice of surgical access in advanced peritonitis can only symbolically be standardized according to modern scoring systems (MPI, SPP, WSES SSS). Laparotomy is necessary for MPI score ≥30 and SPP score > 10 (WSES SSS score > 8). Regardless of MPI, SPP, WSES SSS scores, the absolute contraindications for laparoscopic surgery are dense non-removable fibrin deposits, interintestinal abscesses, purulent recesses, intra-abdominal pressure > 20 mm Hg or small intestine dilation> 3 cm, sepsis or septic shock (qSOFA score 2-3), previous open abdominal surgery, unstable hemodynamics, technical difficulties. Conversion should be used at any doubt.

Conclusion: Careful patient selection, surgical experience and training in laparoscopic technique are decisive factors for wider use of laparoscopic approach in patients undergoing emergency abdominal surgery.

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[腹腔镜手术治疗晚期腹膜炎]。

目的考虑到晚期腹膜炎的局部和全身表现，确定晚期腹膜炎患者选择手术入路的标准：我们分析了 588 名晚期腹膜炎患者的治疗结果。最常见的腹膜炎病因是破坏性急性阑尾炎（273 例）、胃十二指肠溃疡穿孔（165 例）和急性胆囊炎（59 例）。为了确定晚期腹膜炎选择手术入路的标准，我们分析了MPI、SPP和WSES SSS评分的治疗结果：结果：根据现代评分系统（MPI、SPP、WSES SSS），晚期腹膜炎手术入路的选择只能象征性地标准化。如果 MPI 评分≥30 分，SPP 评分大于 10 分（WSES SSS 评分大于 8 分），则必须进行腹腔手术。无论 MPI、SPP、WSES SSS 评分如何，腹腔镜手术的绝对禁忌症是：致密的不可清除的纤维蛋白沉积、肠间脓肿、化脓性凹陷、腹内压> 20 mm Hg 或小肠扩张> 3 cm、败血症或脓毒性休克（qSOFA 评分 2-3）、既往开腹手术、血流动力学不稳定、技术困难。如有任何疑问，应立即转为腹腔镜手术：结论：谨慎选择患者、手术经验和腹腔镜技术培训是在急诊腹部手术患者中广泛使用腹腔镜方法的决定性因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Khirurgiya Medicine-Medicine (all)

CiteScore

0.70

自引率

0.00%

发文量

161

期刊介绍： Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень