Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis
Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis
复制标题
使用市售真空辅助闭合系统治疗腹部脓毒症患者的开腹
作者：
D. Wondberg;Hannes J. Larusson;U. Metzger;A. Platz;U. Zingg
背景用于治疗开放腹部的腹部真空辅助闭合（V.A.C.）系统主要用于具有高原发筋膜闭合率的创伤患者。 V.A.C. 的使用腹部脓毒症的治疗技术尚未完善。方法所有腹部脓毒症患者均接受腹部 V.A.C. 治疗。对 2004 年至 2007 年期间的系统进行了前瞻性评估。终点为筋膜闭合、V.A.C. 相关发病率和随访时生活质量评分 (SF-36)。 结果 本研究纳入了 30 名腹部脓毒症患者。 10 例患者可进行一期筋膜闭合，4 例可部分闭合，16 例无需闭合。 V.A.C. 的中位数变化为 3（范围：1-10）。九名患者死亡。 V.A.C.相关的发病率如下：2个瘘管、3个筋膜边缘坏死、1个皮肤水泡以及4个筋膜和泡沫之间的小肠脱垂。单变量分析显示没有变量影响初次闭合率或 V.A.C. 相关发病率。死亡率受年龄（P < 0.001）、呼吸衰竭（P = 0.01）和肺炎（P = 0.03）的显着影响。在后续行动中，V.A.C.与正常人群相比，患者的身体健康评分较低，心理健康评分相似。结论腹部V.A.C.开腹治疗腹部脓毒症患者。系统安全，具有良好的长期生活质量。这些患者的一期闭合率明显低于创伤患者。 V.A.C. 期间逐步关闭筋膜。应尝试进行改变以避免筋膜边缘的额外侧向收缩。通过仔细的手术技术可以避免 V.A.C. 相关的并发症。
BackgroundAbdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established.MethodsAll patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up.ResultsThirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1–10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (P < 0.001), respiratory failure (P = 0.01), and pneumonia (P = 0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population.ConclusionsTreatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical technique.