van Ramshorst Gabriëlle H, Salu Nathalie E, Bax Nikolaas M A, Hop Wim C J, van Heurn Ernst, Aronson Daniel C, Lange Johan F
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
World J Surg. 2009 Jul;33(7):1509-13. doi: 10.1007/s00268-009-0058-7.
In the limited literature concerning abdominal wound dehiscence after laparotomy in children, reported incidences range between 0.2-1.2% with associated mortality rates of 8-45%. The goal of this retrospective case-control study was to identify major risk factors for abdominal wound dehiscence in the pediatric population.
Patients younger than aged 18 years who developed abdominal wound dehiscence in three pediatric surgical centers during the period 1985-2005 were identified. For each patient with abdominal wound dehiscence, four controls were selected by systematic random sampling. Patients with (a history of) open abdomen treatment or abdominal wound dehiscence were excluded as control subjects. Putative relevant patient-related, operation-related, and postoperative variables for both cases and control subjects were evaluated in univariate analyses and subsequently entered in multivariate stepwise logistic regression models to identify major independent predictors of abdominal wound dehiscence.
A total number of 63 patients with abdominal wound dehiscence and 252 control subjects were analyzed. Mean presentation of abdominal wound dehiscence was at postoperative day 5 (range, 1-15) and overall mortality was 11%. Hospital stay was significantly longer (p < 0.001) in the case group (median, 42 vs. 10 days). Major independent risk factors for abdominal wound dehiscence were younger than aged 1 year, wound infection, median incision, and emergency surgery. Incisional hernia was reported in 12% of the patients with abdominal wound dehiscence versus 3% in the control group (p = 0.001).
Abdominal wound dehiscence is a serious complication with high morbidity and mortality. Median incisions should be avoided whenever possible.
在关于儿童剖腹手术后腹部伤口裂开的有限文献中，报道的发生率在0.2%至1.2%之间，相关死亡率为8%至45%。这项回顾性病例对照研究的目的是确定儿科人群腹部伤口裂开的主要危险因素。
确定了1985年至2005年期间在三个儿科手术中心发生腹部伤口裂开的18岁以下患者。对于每例腹部伤口裂开患者，通过系统随机抽样选择四名对照。有开放腹部治疗史或腹部伤口裂开的患者被排除作为对照对象。对病例组和对照组假定相关的患者相关、手术相关和术后变量进行单因素分析，随后纳入多因素逐步逻辑回归模型，以确定腹部伤口裂开的主要独立预测因素。
共分析了63例腹部伤口裂开患者和252例对照对象。腹部伤口裂开的平均出现时间为术后第5天（范围1至15天），总死亡率为11%。病例组的住院时间明显更长（p<0.001）（中位数，42天对10天）。腹部伤口裂开的主要独立危险因素为年龄小于1岁、伤口感染、正中切口和急诊手术。腹部伤口裂开患者中有12%报告发生切口疝，而对照组为3%（p = 0.001）。
腹部伤口裂开是一种严重并发症，发病率和死亡率高。应尽可能避免正中切口。
