Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):113-120. doi: 10.1007/s00068-019-01205-2. Epub 2019 Aug 26.
Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment.
A retrospective review of all patients that underwent midline laparotomy between January 2008 and December 2012 was performed. Both factors predicting open abdominal treatment and possibility to close the fascia afterwards were identified and analyzed by univariate and multivariate analyses.
775 laparotomies in 525 patients (60% male) were included. 109 patients (21%) had an open abdomen with a mortality rate of 27%. Male gender and acidosis were associated with open abdominal treatment. In 54%, the open abdomen could be closed by delayed fascial closure. The number of laparotomies both before and during temporary abdominal treatment was associated with failure of closure.
In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures. Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.
在一些情况下，如损伤控制手术中的缩短手术或由于器官膨胀或腹内压增加而无法关闭时，常需要进行临时腹部关闭。最终目标是最终关闭筋膜；然而，对于预测腹部关闭的因素知之甚少。本研究的目的是确定与需要进行开放性腹部手术相关的特征，以及指示在开放性腹部治疗一段时间后进行延迟筋膜关闭的可能性。
对 2008 年 1 月至 2012 年 12 月期间接受中线剖腹术的所有患者进行了回顾性分析。通过单变量和多变量分析确定并分析了预测开放性腹部治疗的因素和随后关闭筋膜的可能性。
共纳入 525 例患者（60%为男性）的 775 例剖腹术。109 例患者（21%）行开放性腹部手术，死亡率为 27%。男性和酸中毒与开放性腹部治疗相关。54%的开放性腹部可以通过延迟筋膜关闭来闭合。临时腹部治疗前和期间的剖腹术次数与闭合失败相关。
在这项研究中，男性和酸中毒等生理紊乱是开放性腹部治疗的独立预测因素。此外，延迟筋膜闭合的成功取决于腹部手术的次数。此外，根据我们的经验，我们建议尽早改变治疗方式，以防止多次徒劳无益的关闭腹部尝试。
