[Differentiated surgical therapy of diffuse peritonitis--a prospective study].

Leber, Magen, Darm Pub Date : 1996-05-01
G J Winkeltau, P Bertram, J Braun, V Schumpelick
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Abstract

Patients and methods: In a prospective protocol 86 consecutive patients with a diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen (FRG) from January 1992 to June, 1994. According to the "Mannheim Peritonitis-Score" three different stages were treated with different procedures. Stage-I-peritonitis (mild forms, MPS 0-20) was treated with the so-called standard procedure, Stage-II-cases (MPS: 21-29) with the closed postoperative lavage and severe stage-III-cases (MPS > 29) with the so-called "Etappenlavage" (multiple reexplorations and intraoperative lavage).

Results: 36 patients showed stage-I-, 29 stage-II-, and 21 stage-III-peritonitis. Mortality was 3% (1/36) in stage-I-, 24% (7/29) in stage-II-, and 33% (7/21) in stage-III-groups. The overall mortality of the whole group was 17% (15/86). The statistically expected mortality was 38% according to the MPS and 33% related to the APACHE-II-Score.

[弥漫性腹膜炎的差异化手术治疗——一项前瞻性研究]。
患者和方法:在一项前瞻性方案中,从1992年1月至1994年6月,在亚琛rwt大学外科诊所连续治疗86例弥漫性腹膜炎患者。根据“曼海姆腹膜炎评分”,三个不同阶段采用不同的治疗方法。i期腹膜炎(轻度形式,MPS 0-20)采用所谓的标准程序治疗,ii期病例(MPS 21-29)采用术后闭式灌洗,严重iii期病例(MPS > 29)采用所谓的“尾灌洗”(多次再探查和术中灌洗)。结果:i期腹膜炎36例,ii期腹膜炎29例,iii期腹膜炎21例。i -期死亡率为3% (1/36),ii -期死亡率为24% (7/29),iii期死亡率为33%(7/21)。全组总死亡率为17%(15/86)。根据MPS的统计预期死亡率为38%,与APACHE-II-Score相关的统计预期死亡率为33%。
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