Singh K, Chhina R S
Department of Emergency Surgery, Dayanand Medical College and Hospital, Ludhiana.
Indian J Gastroenterol. 1993 Jan;12(1):1-4.
Continuous peritoneal lavage, staged laparotomies and radical peritoneal debridement have been used to reduce mortality from severe abdominal sepsis. Recently, open abdomen technique using a 'zipper' with or without mesh for abdominal lavage has shown promising results.
To evaluate open abdominal technique using a zipper in patients with advanced diffuse peritonitis with impending or established multiple organ failure.
Modified open abdomen technique using zipper with or without mesh was used for abdominal closure in eight patients with severe generalized peritonitis (APACHE-II score range 27-30).
Zipper was inserted at first laparotomy in three patients, at second exploration in four and at the time of third laparotomy in one case. Two patients required strips of mesh in addition to zipper. Six of eight patients survived and were discharged after an average period of 27 days. Two deaths were due to multisystem organ failure. In four patients additional surgical procedures like closure of perforation, temporary ileostomy and resection anastomosis of small bowel was carried out through the zipper. Zipper-mesh were removed an average of 10.5 days after insertion. Three patients developed incisional hernia at 6 months follow-up.
This technique merits further controlled trials to ascertain its indications and benefits.
持续腹腔灌洗、分期剖腹手术和根治性腹膜清创术已被用于降低严重腹部脓毒症的死亡率。最近，使用带或不带网片的“拉链”的开放腹腔技术已显示出有前景的结果。
评估在患有晚期弥漫性腹膜炎且即将发生或已发生多器官功能衰竭的患者中使用拉链的开放腹腔技术。
采用改良的使用带或不带网片的拉链的开放腹腔技术对8例严重全身性腹膜炎患者（急性生理与慢性健康状况评分系统II评分范围为27 - 30）进行腹壁关闭。
3例患者在首次剖腹手术时插入拉链，4例在二次探查时插入，1例在第三次剖腹手术时插入。2例患者除拉链外还需要网片条。8例患者中有6例存活，平均27天后出院。2例死亡归因于多系统器官功能衰竭。4例患者通过拉链进行了额外的外科手术，如穿孔修补、临时回肠造口术和小肠切除吻合术。拉链 - 网片平均在插入后10.5天取出。3例患者在6个月随访时出现切口疝。
该技术值得进一步进行对照试验以确定其适应证和益处。
