Application Of Vaccum-assisted Clousure In Open Abdomen With Enteroatmospheric Fistulae And Analysis Of Related Factors Of Delay Primary Fascial Closure

PART1 Application of Vaccum-assisted Clousure in open abdomen with enteroatmospheric fistulaeObjective To investigate the feasibility and therapeutic efficacy of applicating Vaccum-assisted Clousure in open abdomen with enteroatmospheric fistulae.Methods The clinical data of 45 Cases of intestinal fistulae and complicated Intra-abdominal Infection patients received open abdomen admitted from Feb 2012 to Nov 2014 in Jin ling Hospital were analyzed retrospectively.According temporary abdominal closure measures were divided into experimental group(negative auxiliary abdomen was closed)and the control group(polypropylene mesh abdomen was closed).Results All of 45 patients were treated outside the hospital before admission with at least once abdominal surgery,intestinal fistula after operation for severe trauma highest proportion of 51.1%,open abdomen with Multiple fistula highest proportion of 29.0%.All patients were line-abdominal fistula at least befor opening,where the fistula after open abdominal wounds become exposed to the open air intestinal fistula.No significant difference between the two groups of basic information.13 cases open abdomen due to incision efection(experimental group VS controlgroup 5vs.8,p = 0.745);8 cases due to IAH(experimental group VS control group 3 vs.5,p = 0.716),the average abdominal pressure 20mmhg,including three cases of abdominal pressure over 25mmhg;the remaining 24 patients(experimental group VS.control group,12 vs.12,p = 0.835)open abdomen because there is no effective abscess drainage.All patients are in a state of serious infection on admission.Routine and biochemical tests suggest WBC,neutrophil count,C-reactive protein and procalcitonin,bilirubin,albumin,prealbumin was not statistically differences.Complications happend in 8 cases.6 cases of intestinal fistula:4 cases of enteroatmospheric fistula,1 fistula and 1 terminal ileum fistula.2 patients dead.No significant difference between the two groups of the incidence of complications.All patients received skin grafting within 7 days afer Frozen abdomen formation.The time d from opening to the skin grafting was significantly shorter in experimental group:18.0 ± 2.3VS 31.2 ± 3.2,p<0.001,statistically significant.For experimental group length of stay ICU and hospital d obviously shorter,16.5 ± 4.3 VS 24.2±5.2,p<0.001 and 41.5 ± 10.0VS 52.6 ± 11.1,p = 0.001.The average chaarge of hospitalization(million),the experimental group was lower than control group,24.3 ± 4.6 VS.29.0 ± 5.5,p<0.004.41 patients underwent anastomosis fistula and abdominal reconstructive surgery.Abdominal wall reconstruction surgry time d experimental group VS.control group:118.9 ± 8.5 VS.135.2 ± 6.2,p<0.001.Select the primayr fascia closure or biological patch repair depends on the operation situation.23 of 41 patients achieved primary fascial closure,success rate of 51.1%.Rate of primary fascial closure,experimental group was obvirously higher than control group 70%VS.36%,p = 0.036.Conclusion Application of Vaccum-assisted Clousure in open abdomen with enteroatmospheric fistulae significantly shorter the time from opening abdomen to skin grfating and the length of stay in ICU and hospita and significantly increased the rate of delay primary fascial closure.Vaccum-assisted Clousure is an effective therapeutics for open abdomen with enteroatmospheric fistulae.PART 2 Analysis of related factors of delay primary fascial closure in open abdomen with enteroatmospheric fistulaeObjective To investigate the risk factors for delay primary fascial closure in open abdomen with enteroatmospheric fistulae by using logistic regression analysis.Methods The clinical data of 41 Cases of open abdomen with enteroatmospheric fistulae patients received definitive abdominal wall reconstruction surgery admitted from Feb 2012 to Nov 2014 in Jin ling Hospital were analyzed retrospectively.Related factors of delay primary fascial closure was analysied by logistic regression.Results Success rate of delay primary fascial closure is 56.1%.Univariate analysis find out weather mechanical ventilation,the length of curing in other hospital befor admitting,the length from admitting to opening abdomen,skin grafting area,TAC,the frequency and time of look operations and EEN correlated with delay primary fascial closure.Logistic regression analysis show,delay primary fascial closure significantly associated with VAC,the length from admitting to opening abdomen,the nunber of look operations.Conclusion VAC,the length from admitting to opening abdomen less than 50h and nunber of look operations less than 2 are independent factors for factors of delay primary fascial closure in open abdomen with enteroatmospheric fistulae.Full text conclusion Application of Vaccum-assisted Clousure in open abdomen with enteroatmospheric fistulae significantly shorter the time from opening abdomen to skin grfating and the length of stay in ICU and hospita and significantly increased the rate of delay primary fascial closure.Vaccum-assisted Clousure is an effective therapeutics for open abdomen with enteroatmospheric fistulae.VAC,the length from admitting to opening abdomen less than 50h and nunber of look operations less than 2 are independent factors for factors of delay primary fascial closure in open abdomen with enteroatmospheric fistulae.