Open abdomen managementを知らずに重症外傷患者の "腹" を診療できるか

“Open abdomen” - 腹壁に欠損があり, 腹腔内臓器が外界に露出する状態のことである. 腹部外傷や内因性腹部疾患に対するdamage control surgeryのコンセプトの一般化, 腹部コンパートメント症候群の病態認識の広がりに伴い, open abdomen managementは重症腹部病態患者に対する基本的治療アプローチのひとつとなっている. 外傷患者に対するopen abdomenにおいて, 一時的閉腹法としての陰圧閉鎖療法はもっともポピュラーな方法であり, 腹腔内貯留液体の効果的排除, 筋膜側方退縮予防, ナーシングケアの改善効果などから, その適用が推奨されている...

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Published in日本外傷学会雑誌 Vol. 38; no. 3; pp. 353 - 359
Main Author 久志本, 成樹
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本外傷学会 20.07.2024
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ISSN1340-6264
2188-0190
DOI10.11382/jjast.38.3_17

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Abstract “Open abdomen” - 腹壁に欠損があり, 腹腔内臓器が外界に露出する状態のことである. 腹部外傷や内因性腹部疾患に対するdamage control surgeryのコンセプトの一般化, 腹部コンパートメント症候群の病態認識の広がりに伴い, open abdomen managementは重症腹部病態患者に対する基本的治療アプローチのひとつとなっている. 外傷患者に対するopen abdomenにおいて, 一時的閉腹法としての陰圧閉鎖療法はもっともポピュラーな方法であり, 腹腔内貯留液体の効果的排除, 筋膜側方退縮予防, ナーシングケアの改善効果などから, その適用が推奨されている. しかし, 定型的閉腹率と生命転帰への効果は明らかでない. Damage control surgery施行例におけるopen abdomen managementから定型的筋膜閉鎖, 一時的閉腹法としての陰圧閉鎖療法の変遷と位置づけ, 早期閉腹不能例におけるopen abdomenの変化と腹壁再建のためのcomponents separation technique, open abdomen managementの臨床的エビデンスをレビューし, 重症腹部外傷患者に対する定型的治療法のひとつとなっているopen abdomen managementに関して, これまでと今後を考えてみたい.
AbstractList “Open abdomen” - 腹壁に欠損があり, 腹腔内臓器が外界に露出する状態のことである. 腹部外傷や内因性腹部疾患に対するdamage control surgeryのコンセプトの一般化, 腹部コンパートメント症候群の病態認識の広がりに伴い, open abdomen managementは重症腹部病態患者に対する基本的治療アプローチのひとつとなっている. 外傷患者に対するopen abdomenにおいて, 一時的閉腹法としての陰圧閉鎖療法はもっともポピュラーな方法であり, 腹腔内貯留液体の効果的排除, 筋膜側方退縮予防, ナーシングケアの改善効果などから, その適用が推奨されている. しかし, 定型的閉腹率と生命転帰への効果は明らかでない. Damage control surgery施行例におけるopen abdomen managementから定型的筋膜閉鎖, 一時的閉腹法としての陰圧閉鎖療法の変遷と位置づけ, 早期閉腹不能例におけるopen abdomenの変化と腹壁再建のためのcomponents separation technique, open abdomen managementの臨床的エビデンスをレビューし, 重症腹部外傷患者に対する定型的治療法のひとつとなっているopen abdomen managementに関して, これまでと今後を考えてみたい.
Author 久志本, 成樹
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References 8) Fox N, Crutchfield M, LaChant M, et al : Early abdominal closure improves long-term outcomes after damage-control laparotomy. J Trauma Acute Care Surg 2013 ; 75 : 854-858. DOI: 10.1097/TA.0b013e3182a8fe6b.
12) Kushimoto S, Miyauchi M, Yokota H, et al : Damage control surgery and open abdominal management : recent advances and our approach. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi 2009 ; 76 : 280-290. (https : //www.ncbi.nlm.nih.gov/pubmed/20035094).
9) Cheatham ML, Demetriades D, Fabian TC, et al : Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique. World J Surg 2013 ; 37 : 2018-2030. DOI: 10.1007/s00268-013-2080-z.
10) Mahoney EJ, Bugaev N, Appelbaum R, et al : Management of the open abdomen : A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2022 ; 93 : e110-e118. DOI: 10.1097/TA.0000000000003683.
5) Pommerening MJ, DuBose JJ, Zielinski MD, et al : Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery 2014 ; 156 : 431-438. DOI: 10.1016/j.surg.2014.04.019.
6) Cheng Y, Wang K, Gong J, et al : Negative pressure wound therapy for managing the open abdomen in non-trauma patients. Cochrane Database Syst Rev 2022 ; 5 : CD013710. DOI: 10.1002/14651858.CD013710.pub2.
4) Atema JJ, Gans SL, Boermeester MA : Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg 2015 ; 39 : 912-925. DOI: 10.1007/s00268-014-2883-6.
14) Ohbe H, Tagami T, Endo A, et al : Trends in massive transfusion practice for trauma in Japan from 2011 to 2020 : a nationwide inpatient database study. Journal of Intensive Care 2023 ; 11 : 46. DOI: 10.1186/s40560-023-00685-0.
2) Chiara O, Cimbanassi S, Biffl W, et al : International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg 2016 ; 80 : 173-183. DOI: 10.1097/TA.0000000000000882.
7) Bradley MJ, Dubose JJ, Scalea TM, et al : Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy : results from the prospective AAST Open Abdomen registry. JAMA Surg 2013 ; 148 : 947-954. DOI: 10.1001/jamasurg.2013.2514.
15) de Vries Reilingh TS, van Goor H, Rosman C, et al : "Components separation technique" for the repair of large abdominal wall hernias. J Am Coll Surg 2003 ; 196 : 32-37. (http : //www.ncbi.nlm.nih.gov/pubmed/12517546).
1) Coccolini F, Roberts D, Ansaloni L, et al : The open abdomen in trauma and non-trauma patients : WSES guidelines. World J Emerg Surg 2018 ; 13 : 7. DOI: 10.1186/s13017-018-0167-4.
13) Diaz JJ, Jr., Cullinane DC, Khwaja KA, et al : Eastern Association for the Surgery of Trauma : management of the open abdomen, part III-review of abdominal wall reconstruction. J Trauma Acute Care Surg 2013 ; 75 : 376-386. DOI: 10.1097/TA.0b013e318294bee3.
3) Dubose JJ, Scalea TM, Holcomb JB, et al : Open abdominal management after damage-control laparotomy for trauma : a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 2013 ; 74 : 113-120 ; discussion 1120-1122. DOI: 10.1097/TA.0b013e31827891ce.
11) Patel NY, Cogbill TH, Kallies KJ, et al : Temporary abdominal closure : long-term outcomes. J Trauma 2011 ; 70 : 769-774. DOI: 10.1097/TA.0b013e318212785e.
References_xml – reference: 15) de Vries Reilingh TS, van Goor H, Rosman C, et al : "Components separation technique" for the repair of large abdominal wall hernias. J Am Coll Surg 2003 ; 196 : 32-37. (http : //www.ncbi.nlm.nih.gov/pubmed/12517546).
– reference: 4) Atema JJ, Gans SL, Boermeester MA : Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg 2015 ; 39 : 912-925. DOI: 10.1007/s00268-014-2883-6.
– reference: 1) Coccolini F, Roberts D, Ansaloni L, et al : The open abdomen in trauma and non-trauma patients : WSES guidelines. World J Emerg Surg 2018 ; 13 : 7. DOI: 10.1186/s13017-018-0167-4.
– reference: 2) Chiara O, Cimbanassi S, Biffl W, et al : International consensus conference on open abdomen in trauma. J Trauma Acute Care Surg 2016 ; 80 : 173-183. DOI: 10.1097/TA.0000000000000882.
– reference: 12) Kushimoto S, Miyauchi M, Yokota H, et al : Damage control surgery and open abdominal management : recent advances and our approach. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi 2009 ; 76 : 280-290. (https : //www.ncbi.nlm.nih.gov/pubmed/20035094).
– reference: 10) Mahoney EJ, Bugaev N, Appelbaum R, et al : Management of the open abdomen : A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2022 ; 93 : e110-e118. DOI: 10.1097/TA.0000000000003683.
– reference: 7) Bradley MJ, Dubose JJ, Scalea TM, et al : Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy : results from the prospective AAST Open Abdomen registry. JAMA Surg 2013 ; 148 : 947-954. DOI: 10.1001/jamasurg.2013.2514.
– reference: 6) Cheng Y, Wang K, Gong J, et al : Negative pressure wound therapy for managing the open abdomen in non-trauma patients. Cochrane Database Syst Rev 2022 ; 5 : CD013710. DOI: 10.1002/14651858.CD013710.pub2.
– reference: 14) Ohbe H, Tagami T, Endo A, et al : Trends in massive transfusion practice for trauma in Japan from 2011 to 2020 : a nationwide inpatient database study. Journal of Intensive Care 2023 ; 11 : 46. DOI: 10.1186/s40560-023-00685-0.
– reference: 3) Dubose JJ, Scalea TM, Holcomb JB, et al : Open abdominal management after damage-control laparotomy for trauma : a prospective observational American Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg 2013 ; 74 : 113-120 ; discussion 1120-1122. DOI: 10.1097/TA.0b013e31827891ce.
– reference: 13) Diaz JJ, Jr., Cullinane DC, Khwaja KA, et al : Eastern Association for the Surgery of Trauma : management of the open abdomen, part III-review of abdominal wall reconstruction. J Trauma Acute Care Surg 2013 ; 75 : 376-386. DOI: 10.1097/TA.0b013e318294bee3.
– reference: 5) Pommerening MJ, DuBose JJ, Zielinski MD, et al : Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery 2014 ; 156 : 431-438. DOI: 10.1016/j.surg.2014.04.019.
– reference: 9) Cheatham ML, Demetriades D, Fabian TC, et al : Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique. World J Surg 2013 ; 37 : 2018-2030. DOI: 10.1007/s00268-013-2080-z.
– reference: 11) Patel NY, Cogbill TH, Kallies KJ, et al : Temporary abdominal closure : long-term outcomes. J Trauma 2011 ; 70 : 769-774. DOI: 10.1097/TA.0b013e318212785e.
– reference: 8) Fox N, Crutchfield M, LaChant M, et al : Early abdominal closure improves long-term outcomes after damage-control laparotomy. J Trauma Acute Care Surg 2013 ; 75 : 854-858. DOI: 10.1097/TA.0b013e3182a8fe6b.
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Snippet “Open abdomen” - 腹壁に欠損があり, 腹腔内臓器が外界に露出する状態のことである. 腹部外傷や内因性腹部疾患に対するdamage control surgeryのコンセプトの一般化, 腹...
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StartPage 353
SubjectTerms abdominal compartment syndrome
abdominal trauma
damage control
open abdomen
Title Open abdomen managementを知らずに重症外傷患者の "腹" を診療できるか
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