Szmyt Krzysztof, Łukasz Krokowicz, Bobkiewicz Adam, Cybułka Bartosz, Ledwosiński Witold, Gordon Maciej, Alammari Ahmed, Banasiewicz Tomasz, Drews Michał
Pol Przegl Chir. 2015 Mar 1;87(1):22-30. doi: 10.1515/pjs-2015-0013.
Open abdomen technique is a surgical treatment in which the fascia and skin are left open in order to reduce the value of the intra-abdominal pressure. According to the World Society of the Abdominal Compartment Syndrome (WSACS) normal values of the intra-abdominal pressure are between 5 and 7 mm Hg. Intra-abdominal hypertension occurs when the pressure value is equal to or exceeds 12 mm Hg. The aim of the study was to compare the results of the open abdomen treatment using standard methods and negative pressure wound therapy.
The study was in the form of a retrospective analysis of the documentation of the patients treated with open abdomen technique. The study included 37 patients treated in the Department of General and Endocrine Surgery and Gastroenterological Oncology and in the Department of Anesthesiology and Intensive Care of the Medical Sciences since 2009-2012. Patients were divided into two groups: group 1 (n = 20) was treated with standard surgical procedures (laparostomy, repeated peritoneal cavity lavage) and group 2 (n =17) was treated using negative pressure wound therapy (NPWT). The analysed clinical data included the period of hospitalization and clinical outcome (survival vs death), the occurrence of enteroatmospheric fistulae, cyclical determination of the quantitative C-reactive protein levels.
The number of deaths during hospitalization in the group treated with NPWT was lower than in the group treated with standard methods (3 vs 9). The number of fistulae during hospitalization in the group treated with NPWT dropped as compared to the group treated using standard procedures (18% vs 70%). The decrease in the CRP levels was recorded in the group treated with NPWT and its increase - in the group treated with standard methods.
The use of NPWT in patients requiring open abdomen treatment is reasonable due to the positive results with respect to survival rates and the decrease in the number of gastrointestinal fistulae. It is necessary to train the physicians in using this type of therapy in the form of workshops and in the clinical setting.
开放腹腔技术是一种外科治疗方法，即让筋膜和皮肤保持开放状态，以降低腹腔内压力值。根据世界腹腔间隔室综合征协会（WSACS）的标准，腹腔内压力的正常值在5至7毫米汞柱之间。当压力值等于或超过12毫米汞柱时，就会发生腹腔高压。本研究的目的是比较使用标准方法和负压伤口治疗的开放腹腔治疗结果。
本研究采用回顾性分析的形式，分析接受开放腹腔技术治疗的患者的病历资料。研究纳入了2009年至2012年期间在普通与内分泌外科、胃肠肿瘤学以及医学科学麻醉与重症监护科接受治疗的37例患者。患者分为两组：第1组（n = 20）采用标准外科手术（剖腹造口术、反复腹腔灌洗）进行治疗，第2组（n = 17）采用负压伤口治疗（NPWT）。分析的临床数据包括住院时间和临床结局（存活与死亡）、肠气瘘的发生情况、定量C反应蛋白水平的周期性测定。
接受NPWT治疗的组在住院期间的死亡人数低于采用标准方法治疗的组（3例对9例）。与采用标准程序治疗的组相比，接受NPWT治疗的组在住院期间的瘘管数量有所下降（18%对70%）。接受NPWT治疗的组记录到C反应蛋白水平下降，而采用标准方法治疗的组C反应蛋白水平升高。
对于需要开放腹腔治疗的患者，使用NPWT是合理的，因为在生存率和胃肠瘘数量减少方面取得了积极成果。有必要通过举办研讨会和在临床环境中培训医生如何使用这种治疗方法。
