Shigeta Kenta, Kim Shiei, Nakae Ryuta, Igarashi Yutaka, Sakamoto Taigo, Ogasawara Tomoko, Masuno Tomohiko, Arai Masatoku, Yokobori Shoji
Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Surg Today. 2025 Mar;55(3):335-342. doi: 10.1007/s00595-024-02899-7. Epub 2024 Jul 24.
To determine the effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in patients undergoing open abdomen management (OAM).
Data from cases with OAM for at least five days who were admitted to our institution between January 2011 and December 2020 were included. We compared the patient's age, sex, medical history, indication for initial surgery, APACHE II scores, indication for OAM, operative time, intraoperative blood loss, intraoperative transfusion, success of primary fascial closure (rectus fascial closure and bilateral anterior rectus abdominis sheath turnover flap method), success of planned ventral hernia, duration of OAM, and in-hospital mortality between patients undergoing VAWCM (VAWCM cases, n = 27) and vacuum-assisted wound closure (VAWC) alone (VAWC cases, n = 25).
VAWCM cases had a significantly higher success rate of primary fascial closure (70% vs. 36%, p = 0.030) and lower in-hospital mortality (26% vs. 72%, p = 0.002) than VAWC cases. A multivariate logistic regression analysis showed that VAWCM was an independent factor influencing in-hospital mortality (odds ratio, 0.14; 95% confidence interval: 0.04-0.53; p = 0.004).
VAWCM is associated with an increased rate of successful primary fascial closure and may reduce in-hospital mortality.
确定真空辅助伤口闭合与网状介导的筋膜牵引（VAWCM）在接受开放性腹部管理（OAM）的患者中的有效性。
纳入2011年1月至2020年12月期间入住我院且接受OAM至少5天的病例数据。我们比较了接受VAWCM的患者（VAWCM组，n = 27）和仅接受真空辅助伤口闭合（VAWC）的患者（VAWC组，n = 25）的年龄、性别、病史、初次手术指征、急性生理与慢性健康状况评分系统（APACHE II）评分、OAM指征、手术时间、术中失血、术中输血、一期筋膜闭合成功率（腹直肌筋膜闭合和双侧腹直肌前鞘翻转皮瓣法）、计划性腹疝成功率、OAM持续时间和院内死亡率。
与VAWC组相比，VAWCM组的一期筋膜闭合成功率显著更高（70%对36%，p = 0.030），院内死亡率更低（26%对72%，p = 0.002）。多因素逻辑回归分析显示，VAWCM是影响院内死亡率的独立因素（比值比，0.14；95%置信区间：0.04 - 0.53；p = 0.004）。
VAWCM与一期筋膜闭合成功率的提高相关，可能降低院内死亡率。
