腹腔开放疗法治疗腹部创伤及术后并发严重腹腔感染 17 例临床分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

陈为凯 ^1,2 , 王菲 ³ , 于建平 ² , 余稳稳 ² , 汪文杰 ² , 张安 ¹ , 王婧 ¹ , 王文安 ⁴ ,  刘宏斌 ²

1. ;
2. ;
3. ;
4. ;

Corresponding author：

刘宏斌, Email: liuhongbin999@163.com

Keywords：

严重腹腔感染; 腹腔间隔室综合征; 腹腔开放; 并发症

DOI：

10.7507/1007-9424.201910010

Video：

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目的探讨腹腔开放（OA）疗法治疗腹部创伤术后严重腹腔感染的有效性，并进行临床经验总结。方法采用回顾性描述性研究方法，收集 2014 年 1 月至 2019 年 7 月期间中国人民解放军联勤保障部队第九四〇医院收治的 17 例腹部创伤术后严重腹腔感染患者的临床病理资料，男 12 例，女 5 例；年龄 36～63 岁，中位年龄 48 岁。观察患者行 OA 治疗前后急性生理和慢性健康估测（APACHE）Ⅱ评分、器官衰竭评分（sepsis-related organ failure assessment score，SOFA）、腹腔压力、尿量及白细胞计数、中性粒细胞百分比、降钙素原，C-反应蛋白和白细胞介素-6 水平的变化。结果共 11 例患者最终治愈出院。行 OA 治疗后患者的腹腔压力、尿量、C-反应蛋白、白细胞计数、中性粒细胞百分比、APACHEⅡ评分以及 SOFA 评分指标均显著改善，与 OA 治疗前比较，其差异有统计学意义（P<0.01）。6 例患者放弃治疗或死亡，其中中感染致多器官功能衰竭 4 例，腹腔内出血 1 例，呼吸心跳骤停 1 例。结论腹腔开放疗法治疗腹部创伤术后严重腹腔感染可行、有效。

Citation： 陈为凯, 王菲, 于建平, 余稳稳, 汪文杰, 张安, 王婧, 王文安, 刘宏斌. 腹腔开放疗法治疗腹部创伤及术后并发严重腹腔感染 17 例临床分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(8): 1012-1015. doi: 10.7507/1007-9424.201910010 Copy

1.	刘宏斌, 李洪涛, 苏琳, 等. 腹腔开放疗法治疗严重腹腔感染的临床疗效. 中华消化外科杂志, 2014, 13(7): 565-566.
2.	Malbrain ML, Roberts DJ, De Laet I, et al. The role of abdominal compliance, the neglected parameter in critically ill patients—a consensus review of 16. Part 1: definitions and pathophysiology. Anaesthesiol Intensive Ther, 2014, 46(5): 392-405.
3.	Malbrain ML, Chiumello D, Cesana BM, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol, 2014, 80(3): 293-306.
4.	Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res, 1987, 43(1): 14-20.
5.	Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
6.	Smit M, Buddingh KT, Bosma B, et al. Abdominal compartment syndrome and intra-abdominal ischemia in patients with severe acute pancreatitis. World J Surg, 2016, 40(6): 1454-1461.
7.	McCosh AJ. I The treatment of general septic peritonitis1. Ann Surg, 1897, 25(6): 687-697.
8.	Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg, 2000, 24(1): 32-37.
9.	Kılıç E, Uğur M, Yetim İ, et al. Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen. Ulus Travma Acil Cerrahi Derg, 2018, 24(4): 321-326.
10.	韦杰, 文张, 张炼, 等. 重症腹腔感染患者的多学科联合治疗(附 17 例病例分析). 中国普外基础与临床杂志, 2017, 24(2): 190-194.
11.	黎介寿, 尹路. 肠外瘘. 第 2 版. 北京: 人民军医出版社, 2003: 235-246.
12.	任建安. 腹腔开放疗法在严重腹腔感染中的应用. 中华消化外科杂志, 2014, 13(7): 508-510.
13.	Cheatham ML, Safcsak K, Brzezinski SJ, et al. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med, 2007, 35(1): 127-131.
14.	Losanoff JE, Richman BW, Jones JW. Intestinal fistulization in the open treatment of peritonitis. Am J Surg, 2003, 185(4): 394-394.
15.	Lambertz A, Mihatsch C, Röth A, et al. Fascial closure after open abdomen: initial indication and early revisions are decisive factors - a retrospective cohort study. Int J Surg, 2015, 13: 12-16.
16.	Dubose JJ, Scalea TM, Holcomb JB, et al. Open abdominal management after demage-control lapaotomy for trauma:a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg, 2013, 74(1): 113-120.
17.	Hsu YP, Wong YC, Fu CY, et al. Analysis for patient survival after open abdomen for torso trauma and the impact of achieving primary fascial closure: a single-center experience. Sci Rep, 2018, 8(1): 6213.
18.	Morais M, Gonçalves D, Bessa-Melo R, et al. The open abdomen: analysis of risk factors for mortality and delayed fascial closure in 101 patients. Porto Biomed J, 2018, 3(2): e14.
19.	Ribeiro MA Jr, Barros EA, Carvalho SM, et al. Comparative study of abdominal cavity temporary closure techniques for damage control. Rev Col Bras Cir, 2016, 43(5): 368-373.
20.	Petersson P, Montgomery A, Petersson U. Vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction: a novel technique for the prevention of incisional hernia after open abdomen therapy including results from a retrospective case series. Scand J Surg, 2019, 108(3): 216-226.
21.	Hu P, Uhlich R, Gleason F, et al. Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis. World J Emerg Surg, 2018, 13: 43.
22.	Dissanaike S, Pham T, Shalhub S, et al. Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections. J Am Coll Surg, 2008, 207(5): 690-697.
23.	Soop M, Carlson GL. Recent developments in the surgical management of complex intra-abdominal infection. Br J Surg, 2017, 104(2): e65-e74.
24.	刘亚光, 严琦敏, 宋波, 等. 外科危重患者与腹腔室隔综合征 14 例. 西北国防医学杂志, 2010, 31(2): 117-119.
25.	李旭照, 武晓勇, 白槟, 等. 腹腔开放治疗肠瘘并复杂腹腔感染的研究进展. 中华胃肠外科杂志, 2018, 21(12): 1446-1450.

1. 刘宏斌, 李洪涛, 苏琳, 等. 腹腔开放疗法治疗严重腹腔感染的临床疗效. 中华消化外科杂志, 2014, 13(7): 565-566.
2. Malbrain ML, Roberts DJ, De Laet I, et al. The role of abdominal compliance, the neglected parameter in critically ill patients—a consensus review of 16. Part 1: definitions and pathophysiology. Anaesthesiol Intensive Ther, 2014, 46(5): 392-405.
3. Malbrain ML, Chiumello D, Cesana BM, et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!). Minerva Anestesiol, 2014, 80(3): 293-306.
4. Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res, 1987, 43(1): 14-20.
5. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg, 1984, 199(1): 28-30.
6. Smit M, Buddingh KT, Bosma B, et al. Abdominal compartment syndrome and intra-abdominal ischemia in patients with severe acute pancreatitis. World J Surg, 2016, 40(6): 1454-1461.
7. McCosh AJ. I The treatment of general septic peritonitis1. Ann Surg, 1897, 25(6): 687-697.
8. Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg, 2000, 24(1): 32-37.
9. Kılıç E, Uğur M, Yetim İ, et al. Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen. Ulus Travma Acil Cerrahi Derg, 2018, 24(4): 321-326.
10. 韦杰, 文张, 张炼, 等. 重症腹腔感染患者的多学科联合治疗(附 17 例病例分析). 中国普外基础与临床杂志, 2017, 24(2): 190-194.
11. 黎介寿, 尹路. 肠外瘘. 第 2 版. 北京: 人民军医出版社, 2003: 235-246.
12. 任建安. 腹腔开放疗法在严重腹腔感染中的应用. 中华消化外科杂志, 2014, 13(7): 508-510.
13. Cheatham ML, Safcsak K, Brzezinski SJ, et al. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med, 2007, 35(1): 127-131.
14. Losanoff JE, Richman BW, Jones JW. Intestinal fistulization in the open treatment of peritonitis. Am J Surg, 2003, 185(4): 394-394.
15. Lambertz A, Mihatsch C, Röth A, et al. Fascial closure after open abdomen: initial indication and early revisions are decisive factors - a retrospective cohort study. Int J Surg, 2015, 13: 12-16.
16. Dubose JJ, Scalea TM, Holcomb JB, et al. Open abdominal management after demage-control lapaotomy for trauma:a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg, 2013, 74(1): 113-120.
17. Hsu YP, Wong YC, Fu CY, et al. Analysis for patient survival after open abdomen for torso trauma and the impact of achieving primary fascial closure: a single-center experience. Sci Rep, 2018, 8(1): 6213.
18. Morais M, Gonçalves D, Bessa-Melo R, et al. The open abdomen: analysis of risk factors for mortality and delayed fascial closure in 101 patients. Porto Biomed J, 2018, 3(2): e14.
19. Ribeiro MA Jr, Barros EA, Carvalho SM, et al. Comparative study of abdominal cavity temporary closure techniques for damage control. Rev Col Bras Cir, 2016, 43(5): 368-373.
20. Petersson P, Montgomery A, Petersson U. Vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction: a novel technique for the prevention of incisional hernia after open abdomen therapy including results from a retrospective case series. Scand J Surg, 2019, 108(3): 216-226.
21. Hu P, Uhlich R, Gleason F, et al. Impact of initial temporary abdominal closure in damage control surgery: a retrospective analysis. World J Emerg Surg, 2018, 13: 43.
22. Dissanaike S, Pham T, Shalhub S, et al. Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections. J Am Coll Surg, 2008, 207(5): 690-697.
23. Soop M, Carlson GL. Recent developments in the surgical management of complex intra-abdominal infection. Br J Surg, 2017, 104(2): e65-e74.
24. 刘亚光, 严琦敏, 宋波, 等. 外科危重患者与腹腔室隔综合征 14 例. 西北国防医学杂志, 2010, 31(2): 117-119.
25. 李旭照, 武晓勇, 白槟, 等. 腹腔开放治疗肠瘘并复杂腹腔感染的研究进展. 中华胃肠外科杂志, 2018, 21(12): 1446-1450.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

腹腔开放疗法治疗腹部创伤及术后并发严重腹腔感染 17 例临床分析

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