网片介导筋膜牵张的真空辅助伤口闭合优于单纯真空辅助伤口闭合：一项比较研究。
Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study.
机构信息
General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
Department of Industrial and Digital Innovation, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
出版信息
World J Surg. 2018 Jun;42(6):1679-1686. doi: 10.1007/s00268-017-4354-3.
BACKGROUND
Open abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur.
METHODS
Non-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients' records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta "modified" technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), abdominal compartmental syndrome (ACS), cardiovascular disease (CVD) and surgical technique performed were evaluated in a multivariate analysis for mortality and fascial closure prediction.
RESULTS
Ninety-six patients with a median age of 69 (40-78) years were included in the study. Sixty-nine patients (72%) underwent VAWCM. Forty-one patients (68%) achieved primary fascia closure: two patients (5%) were treated with VAWC (37 median days) versus 39 patients (95%) who were treated with VAWCM (10 median days) (p = 0.0003). Forty-eight patients underwent OA treatment due to ACS, and 24 patients (50%) survived compared to 36 patients (75%) from the "other reasons" group (p = 0.01). The ACS group required longer mechanical ventilator support (p = 0.006), length of stay in hospital (p = 0.005) and in ICU (p = 0.04) and had higher SAPS II scores (p = 0.0002).
CONCLUSIONS
The survival rate was 62%. ACS (p = 0.01), SAPS II (p = 0.004), sex (p = 0.01), pre-existing CVD (p = 0.0007) and surgical technique (VAWC vs VAWCM) (p = 0.0009) were determined to be predictors of mortality. Primary fascial closure was obtained in 68% of cases. VAWCM was found to grant higher survival and primary fascial closure rate.
背景
当发生腹部创伤、脓毒症、严重急性腹膜炎和腹腔间隔室综合征（ACS）时，开放性腹部（OA）允许应用损伤控制外科原则。
方法
在一个前瞻性数据库中确定了 2010 年 1 月至 2015 年 12 月期间接受 OA 治疗的非创伤性患者，并对收集的数据进行了回顾性分析。从图表和外科及重症监护病房（ICU）登记处收集患者记录。在真空辅助伤口闭合和网介导筋膜牵引（VAWCM）患者中使用 Acosta“改良”技术实现筋膜闭合。对性别、年龄、简化急性生理学评分 II（SAPS II）、腹腔间隔室综合征（ACS）、心血管疾病（CVD）和手术技术进行多变量分析，以预测死亡率和筋膜闭合。
结果
本研究共纳入 96 例患者，中位年龄 69（40-78）岁。69 例（72%）患者接受 VAWCM 治疗。41 例（68%）患者实现了原发性筋膜闭合：2 例（5%）患者接受 VAWC（37 天中位数）治疗，39 例（95%）患者接受 VAWCM（10 天中位数）治疗（p=0.0003）。48 例患者因 ACS 接受 OA 治疗，其中 24 例（50%）存活，而“其他原因”组 36 例（75%）存活（p=0.01）。ACS 组需要更长时间的机械通气支持（p=0.006）、住院时间（p=0.005）和 ICU 时间（p=0.04），且 SAPS II 评分更高（p=0.0002）。
结论
生存率为 62%。ACS（p=0.01）、SAPS II（p=0.004）、性别（p=0.01）、预先存在的 CVD（p=0.0007）和手术技术（VAWC 与 VAWCM）（p=0.0009）被确定为死亡率的预测因素。68%的病例实现了原发性筋膜闭合。VAWCM 可提高生存率和原发性筋膜闭合率。
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