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成人开放性腹部的处理

Authors
Niels Martin, MD, FACS, FCCM
Babak Sarani, MD, FACS, FCCM
Section Editor
Heidi L Frankel, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
谭晓冬, 主任医师，教授

引言

“开放性腹部”这一术语是指腹壁的缺陷暴露腹部脏器。创伤相关的损伤控制性手术和腹腔间隔室综合征是造成遗留腹部开放的最常见原因。开放性腹部暴露脏器，并导致液体和热量的丧失；在腹部一期闭合、功能性闭合或暴露脏器由移植物覆盖之前，应用暂时性关闭腹部切口技术可减少这些情况。

开放性腹部患者的处理、暂时腹部敷料放置技术，以及关腹时机和方法将总结在此。腹腔间隔室综合征的诊断和治疗将在别处详细讨论。 (参见“成人腹腔间隔室综合征”)

开放性腹部

开放性腹部是一种腹壁缺损，该损伤是由完成腹内手术时有意留有腹部开放性切口或因担忧发生腹腔间隔室综合征而开腹(或再次开腹)造成的。引起严重软组织缺损的腹壁创伤也可能造成开放性腹部。

开放性腹部的处理方法为：经由数种技术之一暂时性关闭腹部切口，然后行间断腹部闭合，最好首先将腹部筋膜边缘拉至一起(一期闭合)，或者如果上述操作不易进行，则使用功能性闭合或简单覆盖。暂时性关闭技术和腹部关闭将在下文讨论。 (参见下文‘暂时性关闭腹部切口’和‘腹部闭合’)

病因 — 造成开放性腹部的最常见情形如下：

                       

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-24.
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