Smidfelt Kristian, Nordanstig Joakim, Wingren Urban, Bergström Göran, Langenskiöld Marcus
Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
SAGE Open Med. 2019 Feb 25;7:2050312119833501. doi: 10.1177/2050312119833501. eCollection 2019.
To investigate whether a strategy of treatment with a primarily open abdomen improves outcome in terms of mortality and major complications in patients treated with open repair for a ruptured abdominal aortic aneurysm compared to a strategy of primary closure of the abdomen.
Retrospective cohort study.
Patients treated with a primarily open abdomen at a centre where this strategy was routine in most ruptured abdominal aortic aneurysm patients were compared to a propensity score-matched control group of patients who had the abdomen closed at the end of the primary operation in a majority of the cases.
In total, 79 patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm at Sahlgrenska University Hospital were compared to a propensity score-matched control group of 148 patients. The abdomen was closed at the end of the procedure in 108 (73%) of the control patients. There was no difference in 30-day mortality between patients treated with a primarily open abdomen at Sahlgrenska University Hospital and the controls, 21 (26.6%) versus 49 (33.1%), p = 0.37. The adjusted odds ratio for mortality at 30 days was 0.66 (95% confidence interval: 0.35-1.25) in patients treated with a primarily open abdomen at Sahlgrenska University Hospital compared to the controls. No difference was observed between the groups regarding 90-day mortality, postoperative renal failure requiring renal replacement therapy, postoperative intestinal ischaemia necessitating bowel resection or postoperative bleeding requiring reoperation.
The study did not show any survival advantage or difference in major complications between patients treated with a primarily open abdomen after open repair for ruptured abdominal aortic aneurysm and propensity-matched controls where the abdomen was primarily closed in a majority of the cases.
探讨与一期缝合腹部的策略相比，对于接受开放性修复术治疗的破裂腹主动脉瘤患者，采用主要为开放腹腔的治疗策略是否能改善死亡率和主要并发症方面的预后。
回顾性队列研究。
在一个大多数破裂腹主动脉瘤患者常规采用该策略的中心，将主要接受开放腹腔治疗的患者与倾向评分匹配的对照组患者进行比较，对照组大多数患者在一期手术结束时缝合腹部。
总共将萨尔格伦斯卡大学医院79例接受开放性修复破裂腹主动脉瘤后主要采用开放腹腔治疗的患者与148例倾向评分匹配的对照组患者进行比较。对照组108例（73%）患者在手术结束时缝合了腹部。萨尔格伦斯卡大学医院主要接受开放腹腔治疗的患者与对照组患者在30天死亡率方面无差异，分别为21例（26.6%）和49例（33.1%），p = 0.37。与对照组相比，萨尔格伦斯卡大学医院主要接受开放腹腔治疗的患者30天死亡率的调整优势比为0.66（95%置信区间：0.35 - 1.25）。两组在90天死亡率、需要肾脏替代治疗的术后肾衰竭、需要肠切除的术后肠缺血或需要再次手术的术后出血方面未观察到差异。
该研究未显示在接受开放性修复破裂腹主动脉瘤后主要采用开放腹腔治疗的患者与大多数病例中主要缝合腹部的倾向评分匹配对照组患者之间在生存优势或主要并发症方面存在差异。
