Björck M, Kirkpatrick A W, Cheatham M, Kaplan M, Leppäniemi A, De Waele J J
Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Regional Trauma Services, Foothills Medical Centre, Calgary, AB, Canada.
Scand J Surg. 2016 Mar;105(1):5-10. doi: 10.1177/1457496916631853. Epub 2016 Feb 29.
In 2009, a classification system for the open abdomen was introduced. The aim of such a classification is to aid the (1) description of the patient's clinical course; (2) standardization of clinical guidelines for guiding open abdomen management; and (3) facilitation of comparisons between studies and heterogeneous patient populations, thus serving as an aid in clinical research.
As part of the revision of the definitions and clinical guidelines performed by the World Society of the Abdominal Compartment Syndrome, this 2009 classification system was amended following a review of experiences in teaching and research and published as part of updated consensus statements and clinical practice guidelines in 2013. Among 29 articles citing the 2009 classification system, nine were cohort studies. They were reviewed as part of the classification revision process. A total of 542 patients (mean: 60, range: 9-160) had been classified. Two problems with the previous classification system were identified: the definition of enteroatmospheric fistulae, and that an enteroatmospheric fistula was graded less severe than a frozen abdomen.
The following amended classification was proposed: Grade 1, without adherence between bowel and abdominal wall or fixity of the abdominal wall (lateralization), subdivided as follows: 1A, clean; 1B, contaminated; and 1C, with enteric leak. An enteric leak controlled by closure, exteriorization into a stoma, or a permanent enterocutaneous fistula is considered clean. Grade 2, developing fixation, subdivided as follows: 2A, clean; 2B, contaminated; and 2C, with enteric leak. Grade 3, frozen abdomen, subdivided as follows: 3A clean and 3B contaminated. Grade 4, an established enteroatmospheric fistula, is defined as a permanent enteric leak into the open abdomen, associated with granulation tissue.
The authors believe that, with these changes, the requirements on a functional and dynamic classification system, useful in both research and training, will be fulfilled. We encourage future investigators to apply the system and report on its merits and constraints.
2009年，一种开放性腹部的分类系统被引入。这种分类的目的是帮助：（1）描述患者的临床病程；（2）标准化指导开放性腹部处理的临床指南；（3）便于不同研究及不同患者群体之间的比较，从而辅助临床研究。
作为世界腹腔间隔室综合征协会对定义和临床指南进行修订的一部分，在对教学和研究经验进行回顾后，2009年的这个分类系统于2013年进行了修订，并作为更新的共识声明和临床实践指南的一部分发表。在引用2009年分类系统的29篇文章中，9篇为队列研究。它们作为分类修订过程的一部分被审查。共有542例患者（平均年龄60岁，范围9 - 160岁）被分类。发现了先前分类系统存在的两个问题：肠气瘘的定义，以及肠气瘘的分级比冻结性腹部轻。
提出了以下修订后的分类：第1级，肠管与腹壁之间无粘连或腹壁无固定（侧方移位），再细分为：1A，清洁；1B，污染；1C，有肠漏。通过缝合、造口外置或永久性肠造口瘘控制的肠漏被视为清洁。第2级，出现固定，再细分为：2A，清洁；2B，污染；2C，有肠漏。第3级，冻结性腹部，再细分为：3A，清洁；3B，污染。第4级，已形成的肠气瘘，定义为开放性腹部存在永久性肠漏，并伴有肉芽组织。
作者认为，通过这些改变，将满足对一个在研究和培训中均有用的功能性和动态分类系统的要求。我们鼓励未来的研究者应用该系统并报告其优点和局限性。
