Hoffmann R, Largiadèr F
Klinik für Viszeralchirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1990 Jun;57(1):47-50.
There are many problems associated with definitive closure of "left open abdomen" and abdominal zip. If the assumption can be made that after an operation multiple lavages will be necessary, we recommend a transverse laparotomy because there is much less retraction of the abdominal wall than with longitudinal laparotomy. Definitive closure with split-skin is inadequate as the missing elasticity especially with underlying small intestine loops leads to tearing, besides the mechanical properties of a thiersch as replacement for the abdominal wall is bad. Should the intra-abdominal infection have affected the abdominal wall itself, the implantation of an abdominal zip is useless as it tears away in a short time. Primary laparostoma is then the therapy of choice. The earlier definitive closure is planned, the easier this can be done. Prognosis does not depend on the way of temporary closure but on underlying pathology and on the possibility of resolving problems in adequate time.
“开放性腹部”和腹部拉链的确定性闭合存在许多问题。如果可以假设手术后需要多次灌洗，我们建议采用横向剖腹术，因为与纵向剖腹术相比，腹壁的牵开要少得多。用分层皮片进行确定性闭合是不够的，因为缺乏弹性，尤其是对于下方的小肠袢，会导致撕裂，此外，用席尔氏筋膜替代腹壁的机械性能也很差。如果腹腔内感染已经影响到腹壁本身，植入腹部拉链是无用的，因为它会在短时间内撕裂。此时，一期造口术是首选的治疗方法。确定性闭合计划得越早，实施起来就越容易。预后不取决于临时闭合的方式，而是取决于潜在的病理情况以及在适当时间解决问题的可能性。
