负压网片筋膜牵引技术在腹腔开放术后晚期筋膜关闭中的应用研究  

Combination of mesh, vacuum and traction closure (MVTC) technique for late closure of the open abdomen

作　　者：黄骞[1] 赵允召[1] 任建安[1] 赵日升[1] 王伟[1] 田维亮[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2013年第1期66-69,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(81270478);江苏省自然科学基金创新学者攀登项目(Bk2010017)

摘　　要：目的探讨在负压辅助下,网片调节的筋膜牵引技术在促进腹腔开放术后晚期筋膜关闭中的应用。方法回顾性研究2006年1月至2011年11月南京军区南京总医院普通外科研究所收治40例因腹腔开放行筋膜牵引治疗病人的临床资料。其中18岁以下,腹腔开放前存在腹壁疝、腹腔开放治疗时间<5d的病人排除在研究之外。结果病人平均年龄(45±10)岁。其中弥漫性腹膜炎病人16例(40%),严重创伤12例(30%),重症胰腺炎8例(20%),腹腔大出血4例(10%)。腹腔开放治疗时间平均为(31.0±6.8)d,负压封闭治疗时间平均为(29.0±6.3)d,负压辅助网片牵引治疗平均时间为(26.0±6.8)d。平均腹壁筋膜关闭率为60%。2例(5%)发生肠空气瘘,肠瘘是导致腹壁筋膜关闭失败的独立危险因素。结论负压网片筋膜牵引技术提高了腹腔开放术后的晚期筋膜关闭率,相关并发症较少。Objective This study aims to explore the combination of Mesh, Vacuum and Traction Closure （MVTC） technique for late closure of the open Abdomen. Methods This retrospective study included forty patients who received vacuum-assisted and mesh-mediated fascial traction treatment between Jan 2006 and Dec 2009. Patients with age less than 18 years, Open abdomen（OR） treatment for fewer than 5 days and abdominal wall hernia before OA treatment, were excluded. Results Average age was 45_＋10 years. Main disease aetiologies were diffuse peritonitis （16 patients）, trauma （12 patients）, severe pancreatitis （8 patients） and intraperitoneal hemorrhage （4 patients）. Average OA treatment time was 31.0_＋6.8 days, and average vacuum-assisted and mesh-mediated fascial traction treatment time was 26.0_＋6.8 days. The complete fascial closure rate was 60 percent. Two patients developed an enteroatmospheric fistula. Intestinal fistula was an independent factor associated with failure of fascial closure. Conclusion The vacuum-assisted and mesh-mediated faseial traction method provided a high fascial closure rate after long-term treatment of OA. Technique-related complications were few.

关 键 词：腹腔开放 暂时性腹腔关闭 负压网片筋膜牵引技术 晚期筋膜关闭 

分 类 号：R6[医药卫生—外科学]