Parsa Hossein, Haji Maghsoudi Leila, Mohammadzadeh Alireza, Hosseini Maryam
Department of Surgery, School of Medicine, Velayat Hospital.
Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Ann Med Surg (Lond). 2024 Jul 19;86(9):4984-4989. doi: 10.1097/MS9.0000000000002335. eCollection 2024 Sep.
Despite the advances in surgical techniques and risk control practices in recent years, open wounds following abdominal laparotomy still have a high prevalence. The purpose of this study is to investigate the risk factors of fascia dehiscence (FD) in abdominal surgery patients.
In this observational study, a total of 60 emergency and elective laparotomy patients were enrolled. For all patients, with (treatment) or without (control) wound dehiscence, a checklist was used to extract data from medical records regarding underlying diseases, suturing method, emergency or elective surgical procedure, duration of surgery less than 180 min, intraoperative bleeding, wound closure method, hernia repair, age, sex, smoking history, comorbidities, type of surgery, colostomy placement, wound complications, re-operation, mortality, wound complications including wound infection, wound dehiscence, incisional hernia, and anastomotic leak, and preoperative readiness assessments such as laboratory tests including C-reactive protein (CRP), Albumin (Alb), etc., were completed, and then comparisons were made.
Patients were examined in two groups: 14 patients (70%) in wound dehiscence with age 40-60 and 6 patients (30%) in non-wound dehiscence with age 60-75. Eight patients (40%) underwent elective surgery, and 12 patients (60%) underwent emergency surgery (=0.2). Fourteen patients (70%) experienced mortality (<0.001) and 13 patients (65%) had Alb less than 3 (<0.001). Fourteen patients (70%) had drain installation (=0.02). It was determined that the increase in CRP levels (compared to pre-dehiscence levels) was observed in 17 out of 20 cases, with the highest difference being CRP=91 and an average increase of 30. None of the patients suspected of anastomotic leakage were confirmed to have it. Dehiscence was typically diagnosed between the 4th and 7th days post-surgery. The colon and rectum were significantly more associated with dehiscence, while the stomach had the lowest association among surgical sites.
Based on this study, FD is more common in patients treated in the emergency room than in elective procedures. Mortality occurred more in patients with FD, and there is a significant relationship between FD with albumin less than 3 and drain placement.
尽管近年来手术技术和风险控制措施有所进步，但腹部剖腹手术后的开放性伤口仍然很常见。本研究的目的是调查腹部手术患者筋膜裂开（FD）的危险因素。
在这项观察性研究中，共纳入了60例急诊和择期剖腹手术患者。对于所有患者，无论有无伤口裂开（治疗组或对照组），都使用一份清单从病历中提取有关基础疾病、缝合方法、急诊或择期手术程序、手术时间少于180分钟、术中出血、伤口闭合方法、疝修补、年龄、性别、吸烟史、合并症、手术类型、结肠造口术、伤口并发症、再次手术、死亡率、伤口并发症（包括伤口感染、伤口裂开、切口疝和吻合口漏）以及术前准备评估（如包括C反应蛋白（CRP）、白蛋白（Alb）等在内的实验室检查）的数据，然后进行比较。
患者分为两组进行检查：14例（70%）伤口裂开患者年龄在40 - 60岁，6例（30%）未发生伤口裂开患者年龄在60 - 75岁。8例（40%）患者接受择期手术，12例（60%）患者接受急诊手术（P = 0.2）。14例（70%）患者死亡（P < 0.001），13例（65%）患者白蛋白低于3（P < 0.001）。14例（70%）患者放置了引流管（P = 0.02）。在20例病例中有17例观察到CRP水平升高（与裂开前水平相比），最高差值为CRP = 91，平均升高30。所有疑似吻合口漏的患者均未得到证实。裂开通常在术后第4天至第7天被诊断出来。结肠和直肠与裂开的相关性显著更高，而胃在手术部位中与裂开的相关性最低。
基于本研究，FD在急诊治疗的患者中比在择期手术中更常见。FD患者的死亡率更高，并且FD与白蛋白低于3以及引流管放置之间存在显著关系。
