Robin-Lersundi A, Vega Ruiz V, López-Monclús J, Cruz Cidoncha A, Abella Alvarez A, Melero Montes D, Blazquez Hernando L, García-Ureña M A
Department of Surgery, Servicio de Cirugía General y Aparato Digestivo, Hospital del Henares, Avda. Marie Curie s/n., 28822, Coslada, Madrid, Spain,
Hernia. 2015 Apr;19(2):329-37. doi: 10.1007/s10029-014-1267-z. Epub 2014 Jun 12.
Survival in critically ill non-trauma patients may be improved by performing temporary abdominal closure using different surgical techniques. We describe the use of expanded polytetrafluoroethylene (ePTFE) mesh for temporary abdominal closure in a group of critical patients. We also evaluate definitive abdominal wall closure in these patients once they are in a stable condition.
We conducted a study of 29 critically ill non-trauma patients who underwent temporary abdominal closure due to sepsis or abdominal compartment syndrome over 7 years at two university hospitals. We analysed factors related to surgical wound type and definitive abdominal wall closure. We evaluated the SAPS 3 severity score and used it to obtain expected mortality. We used the Clavien-Dindo System for Surgical Complications and the Ventral Hernia Working Group Classification during follow-up.
Performing temporary abdominal closure with expanded polytetrafluoroethylene mesh was associated with a mortality rate of 20.68%, which was lower than the expected mortality calculated from the SAPS 3 severity score (38.87 ± 21.60). There was no fistula formation related with this type of prosthetic material. In our study group, definitive abdominal wall closure was performed in the 16 patients who survived (69.5%), and six of them underwent this procedure during the original hospital stay.
Temporary abdominal closure with ePTFE mesh is an effective alternative in some circumstances. We observed a higher survival rate than the predicted figure and there were no cases of enteroatmospheric fistulae using this particular surgical technique. ePTFE facilitates definitive abdominal wall closure, once the patient is in a stable condition.
采用不同手术技术进行临时腹部关闭术可能会提高重症非创伤患者的生存率。我们描述了在一组重症患者中使用膨体聚四氟乙烯（ePTFE）补片进行临时腹部关闭术的情况。我们还评估了这些患者病情稳定后进行确定性腹壁关闭术的情况。
我们对29例重症非创伤患者进行了一项研究，这些患者在两家大学医院因败血症或腹腔间隔室综合征在7年期间接受了临时腹部关闭术。我们分析了与手术伤口类型和确定性腹壁关闭术相关的因素。我们评估了序贯器官衰竭评估（SAPS）3严重程度评分，并使用该评分获得预期死亡率。在随访期间，我们使用了Clavien-Dindo手术并发症系统和腹疝工作组分类法。
使用膨体聚四氟乙烯补片进行临时腹部关闭术的死亡率为20.68%，低于根据SAPS 3严重程度评分计算出的预期死亡率（38.87±21.60）。没有与这种假体材料相关的瘘管形成。在我们的研究组中，16例存活患者（69.5%）进行了确定性腹壁关闭术，其中6例在原住院期间接受了该手术。
在某些情况下，使用ePTFE补片进行临时腹部关闭术是一种有效的替代方法。我们观察到生存率高于预测数字，并且使用这种特定手术技术没有肠气瘘的病例。一旦患者病情稳定，ePTFE便于进行确定性腹壁关闭术。
