真空敷料装置在暂时性关腹中的应用

Clinical application of vacuum pack system for temporary abdominal closure

目的探讨一种新的暂时性关腹方法——真空敷料装置的临床应用。方法用聚丙烯薄膜、手术巾、塑料黏贴膜和引流管等构建真空敷料装置。记录使用此装置患者的各种临床资料和并发症。结果有13例患者共使用真空包扎15次进行暂时性关腹,其中5次(33.3%)是因为腹内压增高无法获得无张力的筋膜对合,4次(26.7%)是为了再次手术探查,2次(13.3%)是因为损伤控制,4次(26.7%)是上述多个因素的联合。7例(53.8%)患者最终完成腹壁全层对合关闭,5例(38.5%)患者无法直接对合腹壁缺损,最后行创面断层皮片植皮;3例(23.1%)患者出现腹腔内脓肿,无1例出现消化道瘘,无内脏脱出。1例(7.7%)在试图关腹之前死亡,与真空包扎无关。结论真空包扎可使患者获得直接腹壁肌肉筋膜层关闭,并发症发生率低、易于掌握,是一种较好的暂时性关腹方法。

Objective To investigate the clinical application of a new temporary abdominal wound closure, vacuum system for temporary management of the open abdomen. Methods Vacuum pack system consisted of polyethylene sheet, surgical towel, silicone drain, adhesive plastic drape. Clinical data of the patients undergoing exploratory celiotomy were recorded, and the indications for such temporary abdominal closure and its complications were reviewed. Results Thirteen trauma patients underwent such vacuum abdominal closure for 15 times, including 5 times （33.3%） for increased intra-abdominal pressure so that tension-free fascial closure was unable to achieve, 4 times （26. 7% ） for reexploration, 2 times（13.3% ） for damage control, and 4 times （26.7%） for combined factors. Finally, seven patients（53.8% ） received direct closure and 5 patients （38.5%） received skin grafting after granulation because the defect couldn＇t be closed directly. One patient （7.7%） died before abdominal closure was attempted. None of the patients developed enterocutaneous fistula and evisceration. Three patients （23.1%） developed intra-abdominal abscess. Conclusions The vacuum pack is a better temporary abdominal wound closure device, and primary closure can be achieved in most of the patients. The technique is simple and easily mastered with a low complication rate.