Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029 HUS, Helsinki, Finland.
World J Emerg Surg. 2021 Jun 10;16(1):32. doi: 10.1186/s13017-021-00376-x.
Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP.
A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls.
Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment.
Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.
在重症急性胰腺炎（SAP）中选择开放腹部（OA）治疗的患者具有挑战性。治疗相关的发病率和不良事件风险很高；然而，难治性腹腔间隔室综合征（ACS）可能是致命的。影响启动 OA 治疗决策的因素在临床上很重要。我们旨在研究这些因素，以帮助了解影响 SAP 患者选择 OA 治疗的因素。
对接受 OA 治疗的 SAP 患者进行单中心研究，并与接受保守治疗的匹配对照患者进行比较。
在研究期间，47 名接受 OA 治疗的患者以 1:1 的比例与接受保守治疗的对照患者相匹配。尿量<20ml/h（OR 5.0，95%CI 1.8-13.7）和 ACS（OR 4.6，95%CI 1.4-15.2）与 OA 治疗独立相关。接受 OA 治疗的患者明显比对照组（6%）更容易发生内脏缺血（34%），P=0.002。有内脏缺血的患者死亡率为 63%。没有发现预测发生缺血的有临床意义的参数。OA 治疗与更高的 90 天总死亡率（43%比 17%，P=0.012）和更高的坏死性胰腺炎手术需求（55%比 21%，P=0.001）相关。在 OA 治疗存活的 33 名（97%）患者中，实现了延迟初次筋膜闭合。
SAP 患者的尿量减少和 ACS 与 OA 治疗的选择独立相关。在接受 OA 治疗的患者中，明显常见潜在的内脏缺血，但似乎难以预测这些患者的缺血情况。
