Kılıç Erol, Uğur Mustafa, Yetim İbrahim, Temiz Muhyittin
Department of General Surgery, Mustafa Kemal University Faculty of Medicine, Hatay-Turkey.
Ulus Travma Acil Cerrahi Derg. 2018 Jul;24(4):321-326. doi: 10.5505/tjtes.2017.95038.
Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum-Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated.
In the study, the temporary abdominal closure methods of the patients with OA during 2013-2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared.
The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05).
In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.
开放性腹部（OA）采用临时腹部闭合方法关闭腹腔，对发生严重腹部脓毒症或腹腔间隔室综合征的患者最为有效。主要使用的技术是真空辅助闭合方法（VACM）和非真空辅助闭合方法（NVACM）。在本研究中，评估了不同腹部闭合方法对发病率和死亡率的影响。
本研究回顾性分析了2013年至2016年期间OA患者的临时腹部闭合方法。确定并比较了OA的病因、死亡率预测评分、最终腹部闭合时间和方法、住院时间、并发症（肠造口瘘、网片感染和切口疝）以及接受VACM和NVACM治疗的患者的死亡率。
本研究纳入了123例行VACM（n = 65）和NVACM（n = 58）的患者。两组在年龄、性别和发病机制方面无差异（p>0.05）。治疗期间VACM/NVACM组的平均急性生理学与慢性健康状况评分系统Ⅱ（APACHE 4）和多器官功能障碍评分（MODS）分别为47/63和11/14（p<0.05）。VACM/NVACM组的平均重症监护和住院时间分别为11/16（天）和22/28（天）（p<0.05）。VACM组和NVACM组的积液和脓肿发生率分别为46.2%和77.6%（p<0.05）。VACM组和NVACM组的肠造口瘘（EAF）发生率分别为15.4%和56.9%（p<0.05）。VACM组和NVACM组的平均腹部闭合时间分别为13天和17天（p<0.05）。VACM组和NVACM组的死亡率分别为18%（n = 18）和55%（n = 32）（p<0.05）。
对于OA患者，临时腹部闭合技术VACM比其他方法具有更低的并发症和死亡率，住院时间更短。因此，它是治疗OA的一种有效且安全的方法。
