异种脱细胞真皮结合封闭负压引流技术临时重建巨大Ⅲ型腹壁缺损

ADM Combined with VSD in the Temporary Reconstruction of Huge TypeⅢAbdominal Wall Defect

目的探讨异种脱细胞真皮结合封闭负压引流技术(VSD)临时重建巨大Ⅲ型腹壁缺损的效果。方法2015年1月至2018年8月,共收治因外伤导致的巨大Ⅲ型腹壁缺损患者6例。早期手术清创探查示腹壁全层缺损,大小15 cm×12 cm^18 cm×15 cm,彻底清除腹壁坏死组织,损伤肠管予以吻合或造瘘;使用打孔的异种脱细胞真皮结合VSD暂时性关腹。结果5例患者早期清创术后未出现迟发性肠瘘或严重腹腔感染,1例高压电击伤患者术后出现吻合口瘘,经腹腔冲洗及多次打孔的异种脱细胞真皮结合VSD治疗后,腹腔感染得以控制,肠管黏连成片,肠管浆膜层肉芽生长良好。结论对于需分次手术修复的巨大Ⅲ型腹壁缺损,早期使用打孔的异种脱细胞真皮基质敷料结合VSD暂时性关腹,可保护外露的肠管、充分引流腹腔内渗出液,有效控制腹腔感染,为后期重建腹壁奠定基础。

Objective To explore the clinical effect of ADM combined with VSD in the temporary reconstruction of huge typeⅢabdominal wall defect.Methods From January 2015 to August 2018,6 patients with huge typeⅢabdominal wall defect were treated.Early surgical debridement exploration revealed a full-layer abdominal wall defect of 15 cm×12 cm to 18 cm×15 cm in size.The necrotic tissue in the abdominal wall was completely removed,and the damaged intestine was anastomosed or colostomywas performed.Perforated ADM combined with VSD was used for temporary abdominal closure.Results No delayed intestinal fistula or severe abdominal infection occurred in 5 patients after early debridement.Anastomotic fistula was occurred in 1 case with high voltage wound.After abdominal irrigation and multiple treatments of dc-ADM combined with VSD,abdominal infectionwas controlled,intestinal adhesion and well growth of granulation were observed.Conclusion For huge typeⅢabdominalwall defect,early reconstruction of abdominal wall using ADM combined with VSD,can protect the exposed intestinal tube,fully drain the exudate from the abdominal cavity,effectively control the abdominal infection,and create ideal conditions for the later reconstruction of abdominal wall.