Akers D L, Fowl R J, Kempczinski R F, Davis K, Hurst J M, Uhl S
Department of Surgery, University of Cincinnati Medical Center, OH.
J Vasc Surg. 1991 Jul;14(1):48-52.
Management of patients after operative repair of abdominal aortic aneurysms can be further complicated if primary closure of the abdominal wall cannot be technically accomplished or is associated with profound increases in intraabdominal and peak inspiratory pressures. We recently treated five patients with ruptured abdominal aortic aneurysms and one patient with a ruptured thoracoabdominal aneurysm whose abdominal incisions had to be closed with a Dacron reinforced, silicone sheet. All patients were hemodynamically unstable either at admission to the hospital or became so during operation. Four patients required the insertion of a silicone rubber sheet at the primary operation because of massive retroperitoneal hematoma or edema of the bowel wall or both. Incisions in two patients were closed primarily, but the patients required reexploration and secondary closure with silicone rubber sheets because of the development of marked increases in peak inspiratory pressures, intraabdominal pressures, and decreased urinary output. Four of the six patients subsequently underwent successful removal of the silicone rubber sheets with delayed primary closure of the abdominal wall, and two others died before removal. The patient with the ruptured thoracoabdominal aneurysm died on postoperative day 20 because of pulmonary sepsis but had a healed abdominal incision. The three surviving patients have been discharged. A silicone rubber sheet may be necessary for closure of the abdominal wall after repair of ruptured abdominal aortic aneurysm in patients where primary abdominal wall closure is impossible or where it results in compromise in respiratory or renal function.
如果腹壁的一期缝合在技术上无法完成，或者与腹内压和吸气峰压的显著升高相关，那么腹主动脉瘤手术修复后患者的管理可能会更加复杂。我们最近治疗了5例腹主动脉瘤破裂患者和1例胸腹主动脉瘤破裂患者，他们的腹部切口不得不使用涤纶加固的硅胶片进行缝合。所有患者在入院时或手术期间血流动力学均不稳定。4例患者在初次手术时因大量腹膜后血肿或肠壁水肿或两者兼有而需要插入硅胶片。2例患者的切口进行了一期缝合，但由于吸气峰压、腹内压显著升高以及尿量减少，患者需要再次探查并用硅胶片进行二期缝合。6例患者中有4例随后成功取出硅胶片，腹壁进行了延迟一期缝合，另外2例在取出硅胶片前死亡。胸腹主动脉瘤破裂患者术后第20天因肺部感染死亡，但腹部切口已愈合。3例存活患者已出院。对于腹主动脉瘤破裂修复术后腹壁无法一期缝合或导致呼吸或肾功能受损的患者，可能需要使用硅胶片来关闭腹壁。
