腹部外傷と感染対策

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  • Prevention of Infections After Abdominal Trauma.

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Prevention of anastomotic leakage is the most important factor in preventing infections after abdominal trauma. In performing intestinal anastomosis, it must be borne in mind that the anastomosis has to be performed in an abnormal environment in many cases. Therefore we use the Albert-Lembert suture for intestinal anastomosis, taking into consideration the pressure resistance of the site to be anastomosed. To preserve the blood flow in the anastomosed region, this suture is performed by the interrupted suture technique. In cases where intraperitoneal infection is marked, the Albert-Lembert suture is combined with the Lembert suture, resulting in a three-layer suture. Selection of one-stage anastomosis or two-stage anastomosis (stoma formation) is based on the severity of shock. One-stage resection and reconstruction is selected in patients with grade I shock. Grade II shock patients are treated by a one-stage operation if they are expected to respond to anti-shock therapy. Stoma formation is selected in grade II shock patients who are expected to resist the anti-shock therapy. In grade III shock cases, stoma formation is always selected to allow more certain prevention of infection. As a rule, anastomotic leakage less than 7 days after surgery is treated by a reoperation, while anastomotic leakage occurring 7 days or more after surgery is treated conservatively. However, in determining the therapeutic strategy for anastomotic leakage in individual cases, we also consider the effectiveness of peritoneal drainage and the liver function. Antibiotics used for prevention or treatment of aerobe infection secondary to abdominal trauma are the cefems. Sulbenicillin and piperacillin are used to prevent or treat anaerobe infection.

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