使用负压创面治疗联合持续筋膜牵张技术行开放性腹部手术后初级筋膜闭合率更高，死亡率更低。
Superior primary fascial closure rate and lower mortality after open abdomen using negative pressure wound therapy with continuous fascial traction.
机构信息
From the Department of Abdominal Surgery, Abdominal Center (S.R., P.M., A.L.), Helsinki University Hospital and University of Helsinki, Helsinki; Division of Digestive Surgery and Urology, Department of Surgery (P.S., T.S.), Turku University Hospital, University of Turku, Turku, Department of Surgery, Satakunta Central Hospital, Pori; Department of Abdominal Surgery (V.K.), Oulu University Hospital, Oulo; Department of Gastroenterology and Alimentary Tract Surgery (M.H., L-M.M.), Tampere University Hospital, Tampere; Department of Surgery (T.P.), Seinäjoki Central Hospital, Seinäjoki; Department of Surgery (J.H.), Satakunta Central Hospital, Pori; Department of Surgery (J.R.), Lapland Central Hospital, Rovaniemi; and Department of Surgery (T.R.), Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Eastern Finland, Finland.
出版信息
J Trauma Acute Care Surg. 2020 Dec;89(6):1136-1142. doi: 10.1097/TA.0000000000002889.
BACKGROUND
Open abdomen (OA) is a useful option for treatment strategy in many acute abdominal catastrophes. A number of temporary abdominal closure (TAC) methods are used with limited number of comparative studies. The present study was done to examine risk factors for failed delayed primary fascial closure (DPFC) and risk factors for mortality in patients treated with OA.
METHODS
This study was a multicenter retrospective analysis of the hospital records of all consecutive patients treated with OA during the years 2009 to 2016 at five tertiary referral hospitals and three secondary referral centers in Finland.
RESULTS
Six hundred seventy-six patients treated with OA were included in the study. Vacuum-assisted closure with continuous mesh-mediated fascial traction (VACM) was the most popular TAC method used (N = 398, 59%) followed by VAC (N = 128, 19%), Bogota bag (N = 128, 19%), and self-designed methods (N = 22, 3%). In multivariate analysis, enteroatmospheric fistula and the number of needed TAC changes increased the risk for failed DPFC (odds ratio [OR], 8.9; 95% confidence interval [CI], 6.2-12.8; p < 0.001 and OR, 1.1; 95% CI, 1.0-1.3; p < 0.001, respectively). Instead, VACM and ruptured abdominal aortic aneurysm as cause for OA both decreased the risk for failed DPFC (OR, 0.1; 95% CI, 0.0-0.3; p < 0.001 and OR, 0.2; 95% CI, 0.1-0.7; p = 0.012). The overall mortality rate was 30%. In multivariate analysis for mortality, multiorgan dysfunction (OR, 2.4; 95% CI, 1.6-3.6; p < 0.001), and increasing age (OR, 4.5; 95% CI, 2.0-9.7; p < 0.001) predicted increased mortality. Institutional large annual patient volume (OR, 0.4; 95% CI, 0.3-0.6; p < 0.001) and ileus and postoperative peritonitis in comparison to severe acute pancreatitis associated with decreased mortality (OR, 0.2; 95% CI, 0.1-0.4; p < 0.001; OR, 0.5; 95% CI, 0.3-0.8; p = 0.009). Kaplan-Meier analysis showed increased survival in patients treated with VACM in comparison with other TAC methods (LogRank p = 0.019).
CONCLUSION
We report superior role for VACM methodology in terms of successful primary fascial closure and increased survival in patients with OA.
LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
背景
开放性腹部（OA）是许多急性腹部灾难治疗策略的有效选择。许多临时腹部闭合（TAC）方法都有使用，但是比较研究的数量有限。本研究旨在检查失败的延迟性初次筋膜闭合（DPFC）的风险因素和 OA 患者死亡率的风险因素。
方法
这是一项对 2009 年至 2016 年在芬兰五家三级转诊医院和三家二级转诊中心接受 OA 治疗的所有连续患者的医院记录进行的多中心回顾性分析。
结果
共有 676 例 OA 患者纳入本研究。真空辅助闭合联合连续网片介导的筋膜牵引（VACM）是最常用的 TAC 方法（N = 398，59%），其次是 VAC（N = 128，19%）、Bogota 袋（N = 128，19%）和自行设计的方法（N = 22，3%）。多变量分析显示，肠-气瘘和需要 TAC 改变的次数增加了 DPFC 失败的风险（比值比[OR]，8.9；95%置信区间[CI]，6.2-12.8；p < 0.001 和 OR，1.1；95%CI，1.0-1.3；p < 0.001）。相反，VACM 和破裂的腹主动脉瘤作为 OA 的原因均降低了 DPFC 失败的风险（OR，0.1；95%CI，0.0-0.3；p < 0.001 和 OR，0.2；95%CI，0.1-0.7；p = 0.012）。总的死亡率为 30%。多变量分析显示，多器官功能障碍（OR，2.4；95%CI，1.6-3.6；p < 0.001）和年龄增长（OR，4.5；95%CI，2.0-9.7；p < 0.001）预测死亡率增加。机构大的年度患者量（OR，0.4；95%CI，0.3-0.6；p < 0.001）和与严重急性胰腺炎相比的术后肠梗阻和腹膜炎与降低的死亡率相关（OR，0.2；95%CI，0.1-0.4；p < 0.001；OR，0.5；95%CI，0.3-0.8；p = 0.009）。Kaplan-Meier 分析显示，与其他 TAC 方法相比，VACM 方法在初次筋膜闭合成功和 OA 患者生存方面具有更好的作用。
结论
我们报告了 VACM 方法在 OA 患者中初次筋膜闭合成功和生存率提高方面的优越作用。
证据水平
治疗/护理管理，IV 级。
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