Tolonen Matti, Mentula Panu, Sallinen Ville, Rasilainen Suvi, Bäcklund Minna, Leppäniemi Ari
From the Department of Abdominal Surgery, Abdominal Center (M.T., P.M., V.S., S.R., A.L.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Abdominal Center (V.S.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland; and Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine(M.B.), Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
J Trauma Acute Care Surg. 2017 Jun;82(6):1100-1105. doi: 10.1097/TA.0000000000001452.
Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates.
This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed.
Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups.
The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later.
Therapeutic/care management study, level IV.
在全球范围内，腹膜炎患者的开放性腹腔（OA）治疗正在增加。各种临时性腹腔关闭装置正在被使用。本研究纳入了患有复杂弥漫性继发性腹膜炎、OA以及负压伤口封闭联合补片介导的筋膜牵引（VAWCM）的患者。本研究的目的是描述延迟一期筋膜缝合和肠-气瘘发生率方面的死亡率和主要并发症。
这是一项针对2008年至2016年间连续患有弥漫性腹膜炎、OA和VAWCM的患者的单学术中心回顾性研究。进行了描述性和单因素分析。
共确定并分析了41例患者。中位年龄为59岁，54%（n = 22）的患者术前被诊断为感染性休克，59%（n = 24）的患者术后发生腹膜炎。死亡率为29%（n = 12），76%（n = 31）的患者入住重症监护病房。OA的中位持续时间为7天，中位换药次数为2次。幸存者中延迟一期筋膜缝合率为92%（n = 33），肠-气瘘发生率为7%（n = 3）。在亚组分析中，对腹膜炎初次剖腹手术时行OA的患者（n = 27）与后续剖腹手术时行OA的患者（n = 14）进行了比较。两组之间无显著差异。
对于患有复杂继发性弥漫性腹膜炎和OA的患者，VAWCM技术在延迟一期筋膜缝合率和低肠-气瘘发生率方面产生了优异的结果。如果可能的话，在初次剖腹手术时关闭腹腔似乎是安全的，即使后期有需要行OA的风险。
治疗/护理管理研究，IV级。
