Ding Weiwei, Wang Kai, Liu Baochen, Fan Xinxin, Wang Shikai, Cao Jianmin, Wu Xingjiang, Li Jieshou
*Research Institute of General Surgery†Surgical Intensive Care Unit‡Department of Radiology and Intervention Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, P.R. China.
J Clin Gastroenterol. 2017 Oct;51(9):e77-e82. doi: 10.1097/MCG.0000000000000799.
Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients.
A single-center, retrospective cohort review was performed in a national tertiary surgical referral center.
Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group.
Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.
损伤控制手术和开放腹腔（OA）已广泛应用于严重创伤患者。然而，当扩展到非创伤环境时，相关信息较少。本研究的目的是评估将OA作为损伤控制手术辅助手段的广泛应用是否能改善急性肠系膜上动脉闭塞患者的临床结局。
在一家国家级三级外科转诊中心进行了一项单中心回顾性队列研究。
2005年1月至2016年6月期间，44例患者接受了OA（OA组），65例患者在被诊断为急性肠系膜上动脉闭塞继发腹膜炎后进行了一期筋膜缝合（非OA组）。通过血管内吸栓、开放取栓或经皮支架置入实现血管再通。在首次急诊手术中，两组间肠切除长度无差异。然而，与OA组患者（13.6%）相比，更多非OA组患者（35.4%）需要再次行肠切除术以切除残留的肠缺血段（P<0.05）。OA在中位时间7天（4至15天）内关闭。OA组平均存活肠段为134 cm，而非OA组为96 cm。术后，非OA组比OA组更多患者发生腹腔内感染（23.1%对6.8%，P<0.01）、腹腔内高压（31%对0，P<0.01）和急性肾衰竭（53.8%对31.8%，P<0.05）。与非OA组相比，OA组短肠综合征的发生率较低（分别为9.1%和36.9%，P<0.01）。与非OA组相比，OA显著降低了30天死亡率（27.3%对52.3%，P<0.01）和1年死亡率（31.
