二院外科急腹膜炎.ppt

膈下脓肿 CT引导下细针穿刺抽脓置管 膈下脓肿 图11 经后腰部切口引流肝下（右）脓肿皮肤切口位置 膈下脓肿 经后腰部切口引流肝下（右）术者示指插入腹膜后直向脓肿 膈下脓肿 临床特点： 盆腔位置最低，脓液易积聚 盆腔腹膜面积小，吸收毒素能力低，全身中毒症状轻。 急性腹膜炎治疗过程中、阑尾穿孔或结直肠手术后，出现体温下降后又升高。 典型的直肠或膀胱刺激症状。 盆腔脓肿 B-ultrasound CT scan 盆腔脓肿 治疗 非手术治疗：中小脓肿，可应用抗生素，辅以热水坐浴温热水灌肠物理透热疗法。 手术治疗：保守治疗无效或脓肿较大者。 1.穿刺抽脓 经直肠 2.切开引流（已婚妇女可经后穹隆穿刺后切开） 盆腔脓肿 穿刺抽脓 盆腔脓肿 扩大切口充分引流 盆腔脓肿 盆腔脓肿 经直肠切开引流 1 2 3 指脓液被包围在肠管、肠系膜与网膜之间的脓肿。 可单发，可多发，可出现粘连性肠梗阻。 病人出现化脓感染的症状，并有腹胀、腹痛、腹部压痛或扪及包块。 脓肿破溃入肠管或膀胱形成内瘘，脓液随大小便排出。 非手术治疗无效或肠梗阻时，考虑剖腹探查，并行引流术。 肠间脓肿 THE END结束 * * Bacterial contamination of peritoneum due to spillage from a raptured intraabdominal viscus – Primary disorder of abdominal viscera, blunt/penetrating injury, or abdominal surgery ? Organisms involved differs according to site of injury – Stomach: acidic environment, acid resistant MOS eg Candida; oropharyngeal origin MOS, Bacteroids, Streps etc – Colon: E coli, Bacterois fragillis, Enterobacter, Klebsella, Pseudomonas * ? No apparent source of contamination! ? Affects mostly alcoholic liver cirrhosis, and those patients on peritoneal dialysis ? In 80% of cases single organism involved – High index of suspicion for secondary peritonitis if more than one organism! – E. coli and Streptococci pneumonia involved ? Speculations about the spread – Haematogenous spread (damaged liver and altered portal circulation) – Translocation through an intact bowel, failing liver implicated * ? Also known as recurrent peritonitis, common complication of intraabdominal infection in ICU – Follows severe secondary peritonitis in critically patients (catabolic state) ? Differs from secondary peritonitis in its microbial flora and lack of response to appropriate surgical and antibiotic therapy ? Common infecting MOS: often MDR – Candida, Entercoccus, Staphylococcus epidermidis, and Enterobacter – Infection source are poorly localized at laparotomy * ? Also known as recurrent peritonitis, common complication of intraabdominal infection in ICU – Follows severe secondary peri