Rezende-Neto Joao, Rice Timothy, Abreu Emanuelle Savio, Rotstein Ori, Rizoli Sandro
Department of Surgery Division of General Surgery, University of Toronto, St. Michael's Hospital, 30 Bond Street, Rm 3-074 Donnelly Wing, Toronto, ON M5B 1 W8 Canada.
Hospital Risoleta Tolentino Neves, Federal University of Minas Gerais, Minas Gerais, Brazil.
World J Emerg Surg. 2016 Jun 14;11:28. doi: 10.1186/s13017-016-0083-4. eCollection 2016.
A systematic approach to the appropriate use of the open abdomen strategy has not been described. We propose three fundamental reasons for the use of this strategy, anatomical, physiological and logistical. Anatomical reasons pertain to the inability to bring the fascial edges together including soft tissue defects. Physiological reasons relate to features of systemic dysfunction. Logistical reasons involve any anticipated abdominal re-intervention while preserving fascia. These categories occur either as a single reason or in any combination.
A single-center prospective observational study of patients with open abdomens in trauma and acute abdomen. Surgeons were asked to select from the three reasons (single or any combination of) their motivation for using the open abdomen upon completion of the initial operation. Patients were compared using the non-parametric Wilcoxon two-sample test or Kruskal-Wallis test. Chi-square or Fisher's exact test was used for categorical variables; Statistical significance set at P-value ≤ 0.05.
Forty-five consecutive patients with open abdomens were evaluated (Jan. 1- Dec. 31, 2012). Mean age was 38.8 years, 32 were male, 39 (86.7 %) sustained trauma. The most common single reason for the open abdomen was physiological (24.4 %), 33 patients had multiple reasons, the most common combination being anatomical and physiological (22.2 %). A physiological reason was linked to: lower pH, higher lactate, and lower systolic blood pressure on admission (p < 0.05). A logistical reason was associated with earlier primary fascial closure, intra-operative packing, and bowel left in discontinuity. Logistic regression and adjusted odds ratio of primary fascial closure was: physiological (0.08, 95 % CI, 0.01-0.92, p = 0.043); logistical (6.03, 95 % CI, 1.13-32.29, p = 0.036); and anatomical (0.83, 95 % CI, 0.16-4.18, p = 0.816).
We defined three basic indications for the use of the open abdomen, anatomical physiological and logistical. These indications establish a practical and comprehensive terminology that could help to promote appropriate use of the open abdomen.
尚未有关于合理应用开放腹腔策略的系统方法的描述。我们提出使用该策略的三个基本原因，即解剖学、生理学和后勤学方面的原因。解剖学原因涉及无法使筋膜边缘对合，包括软组织缺损。生理学原因与全身功能障碍的特征有关。后勤学原因包括在保留筋膜的同时任何预期的腹部再次干预。这些类别可单独出现或任意组合出现。
对创伤和急腹症患者的开放腹腔情况进行单中心前瞻性观察研究。要求外科医生在初次手术完成后，从三个原因（单个或任意组合）中选择使用开放腹腔的动机。使用非参数Wilcoxon双样本检验或Kruskal-Wallis检验对患者进行比较。分类变量使用卡方检验或Fisher精确检验；设定统计学显著性为P值≤0.05。
对2012年1月1日至12月31日期间连续的45例开放腹腔患者进行了评估。平均年龄为38.8岁，男性32例，39例（86.7%）为创伤患者。开放腹腔最常见的单一原因是生理学方面的（24.4%），33例患者有多种原因，最常见的组合是解剖学和生理学方面的（22.2%）。生理学原因与入院时较低的pH值、较高的乳酸水平和较低的收缩压有关（p<0.05）。后勤学原因与早期一期筋膜关闭、术中填塞以及肠管离断有关。一期筋膜关闭的逻辑回归和调整优势比为：生理学方面的（0.08，95%可信区间，0.01 - 0.92，p = 0.043）；后勤学方面的（6.03，95%可信区间，1.13 - 32.29，p = 0.036）；解剖学方面的（0.83，95%可信区间，0.16 - 4.18，p = 0.816）。
我们定义了开放腹腔使用的三个基本指征，即解剖学、生理学和后勤学指征。这些指征建立了一个实用且全面的术语体系，有助于促进开放腹腔的合理应用。
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