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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2025, Vol. 19 ›› Issue (05) : 493 -497. doi: 10.3877/cma.j.issn.1674-392X.2025.05.002

所属专题： 文献；

论著

基底膜生物补片内脏保护囊在负压辅助临时关腹治疗期间预防肠空气瘘的临床应用
陈国良1, 苏宁1, 邵国益2, 张剑1,†()   
  1. 1200003　海军军医大学第二附属医院（上海长征医院）肛肠外科
    2214400　江苏，南通大学附属江阴医院　江阴市人民医院城中普通外科一科
  • 收稿日期:2025-08-28 出版日期:2025-10-18
  • 通信作者: 张剑
  • 基金资助:
    国防科技卓越青年科学基金(2019-JCJQ-ZQ-002); 军队高层次科技创新人才工程学科拔尖人才计划(第（2020）BJ06038); 上海市东方学者(SHSDFXZZJ); 国防科技应用推进计划项目(14BKJ050225000Y)

Clinical application of a basement membrane biopatch visceral protective sac for preventing enteroatmospheric fistula during negative pressure assisted temporary abdominal closure

Guoliang Chen1, Ning Su1, Guoyi Shao2, Jian Zhang1,†()   

  1. 1Department of Colorectal Surgery, Shanghai Changzheng Hospital, The Second Affiliated Hospital of Naval Medical University, Shanghai 200003, China
    2Department of General Surgery I, Jiangyin People's Hospital, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin 214400, Jiangsu Province, China
  • Received:2025-08-28 Published:2025-10-18
  • Corresponding author: Jian Zhang
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引用本文：

陈国良, 苏宁, 邵国益, 张剑. 基底膜生物补片内脏保护囊在负压辅助临时关腹治疗期间预防肠空气瘘的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(05): 493-497.

Guoliang Chen, Ning Su, Guoyi Shao, Jian Zhang. Clinical application of a basement membrane biopatch visceral protective sac for preventing enteroatmospheric fistula during negative pressure assisted temporary abdominal closure[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(05): 493-497.

目的

分析基底膜生物补片内脏保护囊在负压辅助临时关腹（NPAAC）治疗期间预防肠空气瘘的安全性、可行性及临床应用效果。

方法

采用回顾性描述性研究方法，收集2024年6月至2025年4月海军军医大学第二附属医院在NPAAC治疗期间使用基底膜生物补片保护内脏的5例患者的临床资料，对患者一般资料、并发症发生率、腹部切口愈合情况、住院时间等进行分析。

结果

本研究中5例患者，男性2例，女性3例，年龄57.0（46.0，60.5）岁，体重指数24.8（22.4，27.1）kg/m2。第一次手术后出现切口感染敞开时间为5.0（4.5，6.0）d。NPAAC治疗前，3例患者腹腔探查时行临切口清创＋腹腔冲洗，2例患者腹腔探查时行临时性回肠造口术＋腹腔冲洗。5例患者经NPAAC治疗后均存活，负压疗法海绵更换次数3.0（2.0，6.0）次。胃肠功能恢复时间为3.0（2.0，8.3）d。负压装置去除时间9.0（7.5，31.0）d。3例患者行确定性切口减张缝合，1例患者行单纯植皮，1例患者先行邮票植皮择期行腹壁重建。住院总时间25.0（22.0，47.5）d；所有患者治疗期间均未出现肠空气瘘，并发症以创面渗血、泌尿系感染、胃潴留、肺部感染为主，经药物治疗均好转。全组随访7.0（4.0，10.5）个月。患者腹壁切口均愈合，1例患者出现腹壁切口疝，暂行保守治疗。

结论

NPAAC前采用基底膜生物补片进行内脏保护安全、可行，可有效降低肠空气瘘的发生率。

关键词: 腹腔开放治疗, 内脏保护层, 负压辅助临时关腹, 基底膜生物补片, 肠空气瘘
Objective

To evaluate the safety, feasibility, and clinical efficacy of a basement membrane biopatch visceral protective sac in preventing enteroatmospheric fistula during negative pressure-assisted temporary abdominal closure (NPAAC).

Methods

A retrospective descriptive study was conducted on 5 patients who underwent NPAAC with the application of the basement membrane biopatch for visceral protection at the Second Affiliated Hospital of Naval Medical University from June 2024 to April 2025. Patient demographics, complication rates, abdominal wound healing status, and hospital length of stay were analyzed.

Results

In this study, there were 5 patients, including two males and three females, with a median age of 57.0 (IQR: 46.0-60.5) years and a median body mass index of 24.8 (IQR: 22.4-27.1) kg/m2. The median time from initial surgery to wound opening due to infection was 5.0 (IQR: 4.5-6.0) days. Prior to NPAAC, three patients underwent wound debridement and peritoneal lavage during exploratory laparotomy, while two received temporary ileostomy plus peritoneal lavage during exploratory laparotomy. All five patients survived following NPAAC treatment. The median number of negative- pressure therapy sponge changes was 3.0 (IQR: 2.0-6.0) times. Gastrointestinal function recovery occurred at a median of 3.0 (IQR: 2.0-8.3) days, and the negative-pressure device was removed after a median of 9.0 (IQR: 7.5-31.0) days. Definitive tension-reducing suture closure was performed in three patients, one received split-thickness skin grafting, and one underwent staged abdominal wall reconstruction following stamp grafting. The median total hospital stay was 25.0 (IQR: 22.0-47.5) days. No enteroatmospheric fistula occurred during treatment. Complications mainly included wound bleeding, urinary tract infection, gastric retention, and pulmonary infection, all of which resolved with drug treatment. During a median follow-up of 7.0 (IQR: 4.0-10.5) months, all abdominal wounds healed. One patient developed an incisional hernia, which was managed conservatively.

Conclusion

This study demonstrates that visceral protection with a basement membrane biopatch before NPAAC is a safe and feasible approach, which can effectively reduce the occurrence of enteroatmospheric fistula.

Key words: Secondary peritonitis, Open abdomen treatment, Visceral protective layer, Negative pressure-assisted temporary abdominal closure, Basement membrane biopatch, Enteroatmospheric fistulae
图1 负压辅助临时关腹创面操作图注：1A基底膜生物补片插入肠管与腹膜之间，两侧筋膜间断缝合牵拉；1B补片上放置KCI海绵并封闭创面连接负压；1C第5次更换负压装置（腹腔开放治疗第26天）；1D腹腔开放治疗后去除负压装置行切口减张缝合。
表1 5例继发性腹膜炎行腹腔开放治疗患者的一般情况
序号 性别 年龄(岁) 体重指数(kg/m2) 原发疾病 手术史 术后切口感染敞开时间(d) 腹腔探查及关腹方式
1 男性 62 24.8 腹膜转移癌 CRS+术中热灌注 5.0 腹腔冲洗+回肠造口+NPAAC
2 女性 57 21.9 直肠癌侵犯膀胱 盆腔脏器联合切除 7.0 腹腔冲洗+切口清创+NPAAC
3 男性 45 28.3 直肠癌侵犯骶骨 盆腔脏器联合切除 5.0 腹腔冲洗+切口清创+NPAAC
4 女性 59 25.9 直肠癌穿孔 直肠癌根治+回肠造口 5.0 腹腔冲洗+切口清创+NPAAC
5 女性 47 22.8 腹膜转移癌 CRS+术中热灌注 4.0 腹腔冲洗+回肠造口+NPAAC
表2 5例继发性腹膜炎行腹腔开放治疗患者临时关腹治疗后患者情况
序号 VAC海绵更换次数 胃肠功能恢复时间(d) 负压装置去除时间(d) 确定性关腹方式 创面植皮时间(d) 腹壁重建时间(d) 住院总时间(d) 术后并发症
1 2 2.0 7.0 减张全层缝合 - - 23.0 创面渗血
2 5 3.5 26.0 单纯植皮 51.0 - 40.0 泌尿系感染
3 7 13.0 36.0 邮票植皮+腹壁重建 48.0 87.0 55.0 胃潴留
4 3 3.0 9.0 减张全层缝合 - - 21.0 创面渗血
5 2 2.0 8.0 减张全层缝合 - - 25.0 肺部感染
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