Establishment and evaluation of an improved rat model of open abdomen

Introduction:This study aimed to establish an animal model of open abdomen(OA)through temporary abdominal closure via different techniques.Methods:Adult male Sprague-Dawley rats were randomly divided into three groups:group A(OA with polypropylene mesh alone);group B(OA with polypro-pylene mesh combined with a patch);and group C(OA with polypropylene mesh and a sutured patch).Vital signs,pathophysiological changes,and survival rates were closely monitored in the rats for 7 days after surgery.Abdominal X-rays and histopathological examinations were performed to assess abdominal organ changes and wound healing.Results:The results showed no significant difference in mortality rates among the three groups(p>0.05).However,rats in group B exhibited superior overall condi-tion,cleaner wounds,and a higher rate of wound healing compared to the other groups(p<0.05).Abdominal X-rays indicated that varying degrees of distal intestinal obstruction in all groups.Histopathological examinations revealed fibrous hyperpla-sia,inflammatory cell infiltration,neovascularization,and collagen deposition in all groups.Group B demonstrated enhanced granulation tissue generation,neovasculari-zation,and collagen deposition compared to the other groups(p<0.05).Conclusions:Polypropylene mesh combined with patches is the most suitable method for establishing an animal model of OA.This model successfully replicated the patho-logical and physiological changes in postoperative patients with OA,specifically the progress of abdominal skin wound healing.It provides a practical and reliable animal model for OA research.

Open abdomen in trauma patients:a double-edged sword

The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula(EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure(TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy(NPT) is the most commonly used TAC method.

Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)patients.Bioelectrical impedance analysis(BIA)is a promising tool for monitoring fluid status and FO.Therefore,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.Methods:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)management.The primary outcome was the 30-day primary fascial closure(PFC)rate.The secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after OA.The Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was built.Results:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,P<0.001).In the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(P<0.001).Additionally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(P<0.001)and fewer complications.Conclusions:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.

Application of a 3D-printed ”fistula stent” in plugging enteroatmospheric fistula with open abdomen: A case report

BACKGROUND Open abdomen(OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the meantime, OA calls for a mass of nursing and the subsequent enteroatomospheric fistula(EAF), which is one of the most common complications of OA therapy, remains a thorny challenge.CASE SUMMARY Our team applied thermoplastic polyurethane as a befitting material for producing a 3 D-printed "fistula stent" in the management of an EAF patient,who was initially admitted to local hospital because of abdominal pain and distension and diagnosed with bowel obstruction. After a series of operations and OA therapy, the patient developed an EAF.CONCLUSION Application of this novel "fistula stent" resulted in a drastic reduction in the amount of lost enteric effluent and greatly accelerated rehabilitation processes.

Investigation of Open Abdomen Visceral Skin Graft Revascularization and Separation from Peritoneal Contents

Background: Despite increasing survival following damage control laparotomy and open abdomen technique, little is known about the biology of visceral skin graft revascularization and separation from peritoneal contents. Methods: Following laparotomy for trauma, patients with visceral edema preventing fascial closure underwent Vicryl mesh closure followed by visceral split-thickness skin grafting and readmission graft excision and abdominal wall reconstruction. Utilizing laser speckle contrast imaging, immunochemical staining of histologic sections, and RT-PCR array technology, we examined the revascularization, microvascular anatomy, morphology, and change in gene expression of visceral skin grafts. Results: Ten patients ranging in age from 25 to 46 years underwent visceral grafting for cutaneous coverage of an open abdomen. Skin graft perfusion peaked at a mean of 350 PU by post-operative day 14 synchronous with closure of meshed interstices, and remained constant until excision. Time to graft excision ranged from 6 to 18 months. CD-31 immunostaining documented a significant (p = 0.04) increase in vascular surface area in excised grafts compared to control skin. Trichrome staining revealed an 8-fold increase in excised graft thickness. Mesothelial cells were identified within the dermal matrix of excised grafts. RT-PCR demonstrated significant up-regulation of genes involved in matrix structure and remodeling, cytoskeleton regulation, and WNT signaling;and down-regulation of genes involved in inflammation and matrix proteolysis in excised grafts compared to control skin. Conclusion: Our data document early visceral skin graft perfusion and a plateau in revascularization. Histology reveals a robust dermal matrix populated by fibroblasts and mesothelial cells within a complex supporting vascular network. Genetic analysis of excised grafts reveals growth factor, collagen, and matrix remodeling gene expression.

Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen:A case report

Blunt bowel injury(BBI)is relatively rare but life-threatening when delayed in surgical repair or anas-tomosis.Providing enteral nutrition(EN)in BBI patients with open abdomen after damage control surgery is challenging,especially for those with discontinuity of the bowel.Here,we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3.Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed.Postoperatively,the patient was transferred to our trauma center for septic shock and hyperbilirubinemia.Following salvage resuscitation,damage control lapa-rotomy with open abdomen was performed for abdominal sepsis,and a temporary double enterostomy(TDE)was created where the anastomosis was ruptured.Given the TDE and high risk of malnutrition,multiple portions EN were performed,including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube.Besides,chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube.Hyperbilirubinemia was alleviated with the increase in chyme reinfusion.After 6 months of home EN and chyme reinfusion,the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet.For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen,the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.

“Acute postoperative open abdominal wall”: Nosological concept and treatment implications

The so-called 'burst abdomen' has been described for many years and is a well-known clinical condition, whereas the concept of the 'open abdomen' is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of 'acute postoperative open abdominal wall'(acute POAW) is presented, which in turn can be divided into 'intentional' or planned acute POAW and 'unintentional' or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the ther-apeutic approach in the surgical repair of abdominal wallrelated disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

腹腔镜辅助下胃癌根治术与传统开腹术对比研究

目的对比腹腔镜辅助下胃癌根治术与传统开腹术临床疗效与患者应激反应程度。方法回顾性选取我院收治的94例胃癌患者,将其中采用开腹胃癌根治术(ORG)治疗的46例纳入ORG组,采用腹腔镜辅助下胃癌根治术(LAGR)治疗的48例纳入LARG组。对比两组手术情况、术后恢复进程、术后各项指标及术后并发症发生率;术后3个月对比两组血清肿瘤标志物变化情况;随访1年,统计两组生存率、复发率与转移率。结果LARG组均顺利完成手术,未发生中转开腹;术后LARG组患者炎症指标水平低于ORG组(P均<0.05);LARG组手术用时长于ORG组,LARG组术中出血量与切口总长度均小于ORG组(P均<0.05);LARG组患者术后肠功能恢复时间、总住院时间均短于ORG组(P均<0.05);LARG组患者术后疼痛评分和术后并发症总发生率低于ORG组(P均<0.05);术后1年,两组复发率、转移率与生存率均未见统计学差异(P均>0.05)。结论腹腔镜辅助下胃癌根治术与传统开腹术相比,能够达到持平的手术效果,虽手术时间较长但术中出血量减少,术后应激反应程度减轻,术后恢复时间缩短。

三孔腹腔镜手术与开腹手术治疗急性阑尾炎患者的效果

目的:对比三孔腹腔镜手术与开腹手术治疗急性阑尾炎患者的效果。方法:回顾性分析2020年1月—2022年1月尤溪县总医院收治的105例急性阑尾炎患者的临床资料。根据手术方法的不同将其分为开腹组(n=49)和腹腔镜组(n=56)。开腹组给予开腹手术,腹腔镜组给予三孔腹腔镜手术。比较两组围手术期指标,胃肠功能恢复情况,术前及术后3 d应激炎症指标,并发症。结果:腹腔镜组手术时间、住院时间均明显短于开腹组,首次下床时间早于开腹组,术中出血量显著少于开腹组,差异有统计学意义(P<0.05)。腹腔镜组肠鸣音恢复时间、首次排气时间、进食时间均明显早于开腹组,差异有统计学意义(P<0.05)。术后3 d,两组丙二醛(malondialdehyde,MDA)、白细胞介素-6(interleukin-6,IL-6)水平均升高,腹腔镜组MDA、IL-6水平均显著低于开腹组,差异有统计学意义(P<0.05)。腹腔镜组并发症发生率明显低于开腹组,差异有统计学意义(P<0.05)。结论:三孔腹腔镜手术治疗急性阑尾炎可缩短手术时间,减少术中出血,可促进患者术后胃肠功能恢复,减轻氧化应激损伤,降低并发症发生率。

经腹腔镜手术和开腹手术治疗低位直肠癌患者的效果比较

目的探讨经腹腔镜手术和开腹手术治疗低位直肠癌患者的应用价值。方法选取2020年2月至2022年2月赣南医科大学附属兴国医院收治的60例低位直肠癌患者为研究对象,按随机数字表法分作对照组及观察组,均30例。对照组行开腹治疗,观察组行腹腔镜手术,比较两组围手术期指标、肛门功能恢复情况、免疫水平及并发症发生率。结果观察组患者手术时间、肛门排气时间及住院时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);两组患者肛门功能恢复情况比较,差异无统计学意义(P>0.05);两组患者治疗前CD4^(+)、CD4^(+)/CD8^(+)、IgA及IgM比较,差异无统计学意义(P>0.05),观察组患者治疗后CD4^(+)、CD4^(+)/CD8^(+)、IgA及IgM高于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论低位直肠癌应用经腹腔镜手术可获确切临床效果,且免疫功能影响较小,并发症发生率低。

腹腔镜与传统开腹子宫肌瘤剔除术治疗子宫肌瘤对其术后切口感染率和瘢痕发生率的影响

目的:探讨腹腔镜与传统开腹手术治疗子宫肌瘤的临床疗效。方法:抽取时间段为2020年3月至2022年3月,至本院就诊的子宫肌瘤患者,共计90例,随机数字表法分组,对照组45例,传统开腹手术,研究组45例,腹腔镜子宫肌瘤剔除术,将两组手术指标、卵巢功能指标水平、并发症、QOL评分纳入统计学软件中,对比数据差异性。结果:研究组术中出血量、排气时间、下床活动时间、手术时间、住院时间均明显少于(短于)对照组,P<0.05;研究组术前、术后的促卵泡激素、促黄体生成素均无明显差异,P>0.05,说明研究组治疗方式不会明显影响卵巢功能;术后并发症:研究组为6.67%,对照组为22.22%,P<0.05;QOL评分:术前,两组QOL评分均无明显差异,P>0.05,术后,研究组QOL评分均明显高于对照组,P<0.05。结论:对子宫肌瘤患者而言,腹腔镜子宫肌瘤剔除术不会对卵巢功能造成明显的影响,手术安全性较高,便于提高术后生活质量,具有一定的临床借鉴价值。

完全腹腔镜下左肝蒂阻断行左半肝切除术对肝内外胆管结石患者的疗效分析

目的探讨肝内外胆管结石患者治疗中,相比常规开腹手术,开展左肝蒂阻断法行完全腹腔镜左半肝切除术的应用价值。方法选取2013年1月至2022年12月本院病收治的68例肝内外胆管结石患者为研究对象,基于随机数字表法规范化分为两组各34例,对照组实行常规开腹手术,观察组实行完全腹腔镜下左肝蒂阻断法左半肝切除术,观察对比两组手术相关指标、术后并发症率、肝功能指标、术后疼痛程度、生活质量。结果与对照组做对比,观察组患者术中出血量相对少,手术用时明显短,且术后下床活动、肛门排气及住院的时间均更短(P<0.05);对比术后并发症率计算结果,观察组更低(P<0.05);术后,两组AST、ALT、TBiL水平均升高(P<0.05),且观察组与对照组对比(P>0.05);观察组术后1d、2d、3d的VAS评分较对照组明显低(P<0.05);治疗1个月后,两组SF-36评分均升高,且观察组较对照组更高(P<0.05)。结论左肝蒂阻断法行完全腹腔镜左半肝切除术,用于肝内外胆管结石的治疗中,相较于开腹治疗,可降低手术创伤,加快术后康复,且减小并发症几率并减轻疼痛,取得更为理想的治疗效果,促进患者生活质量全面提升。

机器人手术系统、腹腔镜及开腹手术治疗宫颈癌的对比研究

目的：探讨机器人手术系统在宫颈癌手术中的安全性、可行性及其临床应用价值。方法回顾性分析2010年3月至2014年2月在第二炮兵总医院行宫颈癌根治术治疗的75例ⅠA～ⅡA期宫颈癌患者的临床资料，其中机器人（RRH）组23例、腹腔镜（LRH）组15例和开腹（ARH）组37例。结果 RRH组、LRH组及ARH组的出血量分别为（110.6±31.0）ml、（274.2±44.6）ml 和（1219.0±738.7）ml，输血量分别为（17±100）ml、（80±160）ml 和（1000±560）ml，手术并发症的发生率分别为8.6％（2/23）、20.0％（3/15）和48.6％（18/37），术后胃肠道的恢复时间分别为（33.2±17.0）h、（51.0±10.8）h 和（63.7±7.9）h。 RRH组与LRH组及ARH组比较，上述4项指标的差异均有统计学意义（P＜0.05）。结论在宫颈癌根治术中，机器人手术系统较腹腔镜和传统开腹术出血少、术后胃肠道恢复时间短及手术并发症低，提示机器人手术在宫颈癌治疗方面更具安全性、可行性和一定临床价值。

损伤控制性手术在创伤治疗中的应用综述

随着社会经济的快速发展、汽车的增多,交通伤等多种复杂致伤因素导致的创伤病例越来越多。近年来损伤控制性手术(damage control surgery,DCS)用于创伤治疗,提高了严重多发伤患者抢救的成功率。本文主要介绍损伤控制性手术的发展历程,阐述其临床应用及研究进展。

腹腔开放减压疗法在重症急性胰腺炎中的临床应用

目的：探讨腹腔开放减压疗法在重症急性胰腺炎中的临床应用.方法：回顾性总结分析2012年1月至2014年7月广西医科大学第一附属医院收治的24例重症急性胰腺炎合并腹腔间隔室综合征患者的临床资料.术中开放腹腔减压,利用暂时性腹腔关闭技术,聚丙烯网片和（或）无菌3L静脉营养输液袋、膀胱冲洗液袋、负压封闭引流关闭系统材料、黎氏引流管等覆盖敞开腹腔,根据患者恢复情况,逐步于术后7～15 d行确定性关腹术.结果：治愈18例,治疗过程中出现肠瘘3例,腹腔出血4例;死亡4例,死因为严重感染和多器官功能衰竭;放弃治疗出院2例.结论：重症急性胰腺炎合并腹腔间隔室综合征采用腹腔开放减压疗法等支持治疗可以有效的降低腹内压.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

3D-printed “fistula stent” designed for management of enterocutaneous fistula: An advanced strategy

Enterocutaneous fistulas(ECFs) are great challenges during the open abdomen. The loss of digestive juice, water-electrolyte imbalance and malnutrition are intractable issues during management of ECF. Techniques such as "fistula patch" and vacuumassisted closure therapy have been applied to prevent contamination of open abdominal wounds by intestinal fistula drainage. However, failures are encountered due to high-output fistula and anatomical complexity. Here, we report 3 D-printed patient-personalized fistula stent for ECF treatment based on 3 D reconstruction of the fistula image. Subsequent follow-up demonstrated that this stent was well-implanted and effective to reduce the volume of enteric fistula effluent.

新生儿腹腔镜与开腹手术对循环和血气的影响

目的 :观察新生儿腹腔镜和开腹手术对循环、血气的影响 ,旨在提高新生儿腹腔镜手术麻醉的安全性。方法 :4 0例新生儿腹部手术随机分为腹腔镜组 (Ⅰ组 )和开腹组 (Ⅱ组 ) ,每组 2 0例。麻醉均采用气管插管静复全麻 ,监测HR ,MAP ,ECG ,SpO2 ,EtCO2 ,并分别于气 (开 )腹的不同时点抽取动脉血行血气分析。结果 :组内各项指标在气腹前后变化显著 (P <0 .0 5 ) ,Ⅱ组组内相比无显著性差异 (P >0 .0 5 ) ,两组间比较有显著性差异(P <0 .0 5 )。结论 :腹腔镜手术对新生儿的循环和血气虽有较大影响 ,但如能做好充分的术前准备 ,加强围麻醉期监测 ,同样能为新生儿安全实施腹腔镜手术的麻醉。

腹腔开放合并肠空气瘘的防治

腹腔开放能够减轻腹腔内压力,便于清除感染坏死组织,及时止血,及时发现肠外瘘等并发症,目前腹腔开放疗法已成为应用损害控制理念救治严重创伤、重度腹腔感染、腹腔间隙综合征的重要治疗手段。但腹腔开放仍有一些并发症,尤其是继发肠空气瘘,一旦发生肠空气瘘,则需要调整治疗思路,建议采用阶段性治疗策略,同时重视此过程中肠内营养的应用。

腹腔开放技术的研究进展

随着损伤控制性外科理念的普及,人们对腹腔高压、腹腔间室综合征和严重腹腔脓毒症等的处理方法有了新的认识,采用腹腔开放(open abdomen,OA)处理复杂的腹部疾患已成为损伤控制外科的重要组成部分。虽然OA解决了腹腔高压和腹腔间室综合征的主要病理相关难题,但这种技术也伴随着严重的并发症。对OA病理生理新的认识以及临时腹腔关闭新技术的发展促进了对此类患者的治疗以及预后改善。