Mentula P
Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland.
Minerva Chir. 2011 Apr;66(2):153-63.
The open abdomen is increasingly used for the treatment and prevention of abdominal compartment syndrome. The leading non-traumatic conditions that may cause abdominal compartment syndrome requiring surgical decompression include secondary peritonitis, ruptured abdominal aortic aneurysm and severe acute pancreatitis. Patients may also end up with the open abdomen when the laparotomy wound cannot be closed without tension because of excessive visceral swelling. Also, surgical complications such as laparotomy wound dehiscence, may require temporary abdominal closure techniques. In critically ill surgical patients and in situations when second-look laparotomy is mandatory the open abdomen can be utilized in a preventive manner like in damage control trauma surgery. Underlying disease and the indication for the open abdomen significantly contributes to outcome of patient with open abdomen. Non-traumatic aetiology of the open abdomen is associated with lower likelihood of primary fascial closure and higher rate of open abdomen related complications compared with traumatic aetiology. A number of temporal abdominal closure techniques have been described. Ideally, temporal abdominal closure technique should prevent the development of recurrent abdominal compartment syndrome and facilitate later primary fascia closure with low complication rate. Although fascial closure rate varies between techniques, there are few evidence-based data to support one technique over another. However, recent evolution of temporary abdominal closure techniques have decreased the number of patients with frozen abdomen and reduced the need for planned hernia management. Highest fascial closure rates have been achieved with vacuum-assisted closure systems and systems that provide continuous fascial traction.
开放腹腔越来越多地用于治疗和预防腹腔间隔室综合征。可能导致需要手术减压的腹腔间隔室综合征的主要非创伤性疾病包括继发性腹膜炎、腹主动脉瘤破裂和重症急性胰腺炎。当由于内脏过度肿胀而无法无张力地关闭剖腹手术切口时，患者最终也可能会出现开放腹腔的情况。此外，诸如剖腹手术切口裂开等手术并发症可能需要临时的腹部闭合技术。在重症外科患者以及必须进行二次剖腹探查的情况下，开放腹腔可像在损伤控制创伤手术中那样以预防性方式使用。基础疾病和开放腹腔的指征对开放腹腔患者的预后有显著影响。与创伤性病因相比，开放腹腔的非创伤性病因与初次筋膜闭合的可能性较低以及与开放腹腔相关的并发症发生率较高有关。已经描述了多种临时性腹部闭合技术。理想情况下，临时性腹部闭合技术应防止复发性腹腔间隔室综合征的发生，并以低并发症发生率促进后期的初次筋膜闭合。尽管不同技术之间的筋膜闭合率有所不同，但几乎没有循证数据支持一种技术优于另一种技术。然而，临时性腹部闭合技术的最新进展减少了“冰冻腹腔”患者的数量，并减少了计划性疝处理的需求。真空辅助闭合系统和提供持续筋膜牵引的系统实现了最高的筋膜闭合率。
