探讨腔内负压吸引（EVAC）联合创面负压引流（VAC）治疗腹腔开放合并肠空气瘘的临床疗效、安全性及操作规范。

本研究采用描述性病例系列研究方法，回顾性收集分析2020年1月至2024年12月，江阴市人民医院收治的13例腹腔开放合并肠空气瘘患者临床资料。所有患者均接受EVAC（经内镜/经皮置入聚氨酯海绵）联合VAC（聚氨酯海绵覆盖敞开创面）治疗。主要观察指标：住院天数、再手术情况；次要指标：炎症指标（WBC、C反应蛋白、降钙素原）变化、营养状态（白蛋白）改善情况。

13例患者均实现创面植皮覆盖、肠空气瘘口管控至可自行护理，无患者因创面或肠空气瘘管控失败再手术；中位住院时间42（35，98）d。炎症与营养指标治疗前后变化：WBC[（19.8±8.1）×10⁹/L降至（7.4±2.6）×10⁹/L）]、C反应蛋白[（174.9±55.5）mg/L降至（15.6±4.7）mg/L]、降钙素原[（7.1±4.4）ng/ml降至（0.6±0.3）ng/ml）]显著下降（P<0.01）；白蛋白[（23.3±3.1）g/L升至（35.6±2.8）g/L]显著回升（P<0.05）。并发症：疼痛6例（46.2%）、海绵移位和阻塞10例（76.9%）、黏膜渗血2例（15.4%）、创面感染1例（7.7%）、肠梗阻8例（61.5%），无肠穿孔、大出血或死亡病例。

EVAC联合VAC通过"内引流＋外覆盖"双重机制，可有效控制感染、促进肉芽组织增生、减少创面污染、实现肠内营养，是治疗腹腔开放合并肠空气瘘的安全高效方案。

To explore the clinical efficacy, safety, and operational standards of Endoluminal Vacuum-Assisted Closure (EVAC) combined with Vacuum-Assisted Closure (VAC) in treating open abdomen complicated with enteroatmospheric fistula.

This study employed a descriptive case series design. A retrospective analysis was conducted on the clinical data of 13 patients with open abdomen and enteroatmospheric fistula admitted to Jiangyin People's Hospital from January 2020 to December 2024. All patients received EVAC (polyurethane sponge placement via endoscopy/ percutaneously) combined with VAC (polyurethane sponge covering the open wound). Main observation indicators: length of hospital stay, need for reoperation; Secondary indicators: changes in inflammatory markers (WBC, C-reactive protein, procalcitonin), improvement in nutritional status (albumin).

All 13 patients achieved wound coverage with skin grafting and management of enterocutaneous fistulas to the point of self-care. No patient required reoperation due to failure in wound or enterocutaneous fistula management. The median hospital stay was 42 (35, 98) days for the 13 patients. Changes in inflammatory and nutritional indicators before and after treatment: WBC [decreased from (19.8±8.1)×10⁹/L to (7.4±2.6)× 10⁹/L], C-reactive protein [decreased from (174.9±55.5) mg/L to (15.6±4.7) mg/L], and procalcitonin [significantly decreased from (7.1±4.4) ng/ml to (0.6±0.3) ng/ml] (P<0.01); albumin [significantly increased from (23.3±3.1) g/L to (35.6±2.8) g/L] (P<0.05). Complications: 6 cases of pain (46.2%), 10 cases of sponge displacement and obstruction (76.9%), 2 cases of mucosal bleeding (15.4%), 1 case of wound infection (7.7%), and 8 cases of adhesive intestinal obstruction (61.5%). No cases of intestinal perforation, major bleeding, or death occurred.

EVAC combined with VAC effectively controls infection, promotes granulation tissue growth, reduces wound contamination, and achieves enteral nutrition through a "internal drainage+external coverage" dual mechanism. It is a safe and effective approach for treating open abdomen with enteroatmospheric fistula.