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穿孔性憩室炎的损伤控制手术:使用两种不同腹部负压治疗装置的双中心经验

Damage control surgery for perforated diverticulitis: a two center experience with two different abdominal negative pressure therapy devices.

作者信息

Gasser Elisabeth, Alexander Perathoner, Reich-Weinberger Sylvia, Buchner Selina, Kogler Pamela, Zitt Matthias, Kafka-Ritsch Reinhold, Öfner Dietmar

机构信息

Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck , Innsbruck , Austria.

Department of Surgery, Paracelsus Private Medical University Salzburg , Salzburg , Austria.

出版信息

Acta Chir Belg. 2019 Dec;119(6):370-375. doi: 10.1080/00015458.2018.1534397. Epub 2018 Nov 2.

Abstract

The adoption of abdominal negative pressure therapy (NPT) during urgent laparotomy has shown to be helpful to control abdominal sepsis, improve morbidity and increase anastomosis rate. The aim of this study was to compare feasibility and outcome of two different abdominal negative pressure devices. The retrospective two-center study includes 78 consecutive patients with perforated sigmoid diverticulitis, who underwent urgent laparotomy using the ABThera™ (KCI, Wien, Austria) abdominal NPT device (Group A,  = 51) or the Suprasorb® CNP (Lohmann & Rauscher, Wien, Austria) abdominal NPT device (Group B,  = 27). The mean length of abdominal NPT was 3.6 days in Group A and 2.8 days in Group B. Revisional surgery after closure of the abdomen was necessary due to surgical site infections, fascial dehiscence or anastomotic insufficiency in 25% and 29%, respectively. NPT-associated complications like fistula formation or acute bleeding were not observed. Mortality was 15% (Group A) and 7% (Group B). Despite the good feasibility and the well-known positive effect of abdominal NPT, perforated diverticulitis is still associated with high morbidity. However, the analysis did not show significant differences between the two abdominal NPT devices.

摘要

在急诊剖腹手术中采用腹腔负压治疗(NPT)已被证明有助于控制腹腔感染、降低发病率并提高吻合率。本研究的目的是比较两种不同腹腔负压装置的可行性和治疗效果。这项回顾性双中心研究纳入了78例连续的乙状结肠憩室穿孔患者,他们在急诊剖腹手术中使用了ABThera™(KCI,维也纳,奥地利)腹腔NPT装置(A组,n = 51)或Suprasorb® CNP(Lohmann & Rauscher,维也纳,奥地利)腹腔NPT装置(B组,n = 27)。A组腹腔NPT的平均时长为3.6天,B组为2.8天。由于手术部位感染、筋膜裂开或吻合口功能不全,分别有25%和29%的患者在腹部闭合后需要进行再次手术。未观察到与NPT相关的并发症,如瘘管形成或急性出血。死亡率分别为15%(A组)和7%(B组)。尽管腹腔NPT具有良好的可行性和众所周知的积极效果,但憩室穿孔仍与高发病率相关。然而,分析显示两种腹腔NPT装置之间没有显著差异。

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