FAQ

A: Cov ntaub ntawv twg yuav tsum raug xaiv rau cov kab noj hniav intraperitoneal, cov kab noj hniav retroperitoneal, thiab cov kab noj hniav sib cais?
polyvinyl cawv ua npuas ncauj yog pom zoo kom siv nyob rau hauv intraperitoneal thiab retroperitoneal kab noj hniav, thaum polyurethane los yog polyvinyl cawv ua npuas ncauj raug pom zoo rau sab nrauv incisions thiab sab nraud ntawm sutured incisions.(Qib C). Cov ntaub ntawv thiab cov cuab yeej uas yuav tsum tau rau VSD muaj xws li ua npuas ncauj, raj dej, pob tshab nplaum zaj duab xis, thiab tsis zoo siab qhov chaw. sponge-zoo li cov ntaub ntawv ua npuas ncauj yog nyob rau hauv kev sib cuag nrog cov ntaub so ntswg, xws li lub qhov txhab qhov txhab, thiab cov pores yog txuas rau ib leeg. Muaj ob hom khoom siv (1) polyvinyl cawv (PVA), uas muaj qhov pore me me ntawm 0.06-0.27 mm inch thiab lub zog tensile siab (522.4 kPa) thiab yog tawv, thiab (2) polyurethane (PU), uas muaj cov pores loj dua nrog txoj kab uas hla ntawm 0.4-0.27 mm rau 1 tensile zog, yooj yim rau 1 granulation. kPa) thiab yog yooj yim. Kev khaws cia ntawm PU ua npuas ncauj khib nyiab hauv qhov txhab tau pom tias muaj feem cuam tshuam rau kev kho mob.
Hauv kev siv tiag tiag, qhov saum npoo ntawm cov khoom ua npuas ncauj yuav tsum tau them nrog ib qho semipermeable membrane. Tom qab lub cim ntawm qhov tsis zoo siab, cov npuas dej yog tsau nrog cov ntaub so ntswg nyob ib puag ncig los ua kom tiav cov foob. Xav txog qhov cuam tshuam ntawm qhov tsis zoo ntawm cov ntshav hauv plab, feem ntau qhov tsis zoo siab siv rau ntawm lub plab yog qis dua li ntawm ex- tshee thaum siv VSD cov txheej txheem. Tus nqi tuaj yeem teeb tsa ntawm -125 mmHg rau -300 mmHg (-17 kPa txog -40 kPa) rau daim tawv nqaij sab nraum qhov phais, qhov txhab ntxiv peritoneal, lossis hauv lub cev kab noj hniav, thaum rau ib ntus peritoneal kaw thiab intra-abdominal daim ntawv thov, lub siab 5 _1 mmHg yuav tsum tau kho - 50 mmHg (-6.7 txog -23.3 kPa). Txawm hais tias tsis muaj pov thawj qib siab hauv cov tshuaj pov thawj, qhov qis qis qis qis, xws li -50 mmHg txog -80 mmHg, tau pom zoo rau cov neeg mob uas kho cov hnyuv lossis anastomosis.

A: Rau kev phais plab nrog lub hauv paus tseem ceeb uas muaj kev pheej hmoo kis mob, kev siv tshuaj tiv thaiv kab mob VSDis tau pom zoo los pab txo qis qhov pib kis kab mob (Qib B).
Tag nrho cov kab lus tau tham txog kev tiv thaiv kab mob VSD (VSD) rau kev phais plab nrog thawj suture, ntawm 6 yog RCTs thiab 29 yog cov kev tshawb fawb soj ntsuam, Xyoo 2016, WHO tau tshaj tawm cov txheej txheem raws li cov pov thawj-raws li cov pov thawj rau kev tiv thaiv kab mob thiab kev phais mob tom qab kev phais mob hauv cov ntawv thov (SSls) prophylactic NPWT rau theem kuv sutured incisions uas muaj kev pheej hmoo ntawm kis kab mob (kev pom zoo, tsis zoo). Tag nrho ntawm 20 tsab xov xwm raug tshuaj xyuas, suav nrog 6RCTs thiab 14 cov kev tshawb fawb soj ntsuam. Piv nrog rau kev hnav khaub ncaws ib txwm muaj, prophylactic NPWT (NPWT) txo qhov kev pheej hmoo ntawm SSIs hauv cov qhov txhab kaw, Cov pab pawg neeg soj ntsuam ntawm cov txheej txheem phais sib txawv tau qhia tias kev siv VSD txo qhov kev pheej hmoo ntawm SSls hauv plab thiab mob plawv tab sis tsis muaj txiaj ntsig hauv kev phais orthopedic ortraumatic. Hauv cov pab pawg me uas muaj ntau hom kev txiav txim siab (huv-cov kab mob sib kis thiab cov kab txiav huv si), VSD tau pom qhov sib txawv tseem ceeb hauv kev txo qhov tshwm sim ntawm SSls. Los ntawm kev siv tus nqi- kev tshuaj xyuas kev ua tau zoo, Chopra et al. piv nrog kaw-kev phais VSD nrog cov qauv hnav khaub ncaws tom qab kev phais plab kaw hauv siab- cov neeg mob muaj kev pheej hmoo: 829 kev phais plab plab (260 kaw-kab VSDs thiab 569 tus qauv hnav khaub ncaws) tau suav nrog, thiab cov txiaj ntsig tau pom tias kev txiav txim kaw {5SD20.20 US $ 20. piv nrog cov qauv hnav khaub ncaws, tawm tswv yim tias kaw -incision VSD yog tus nqi- txoj kev siv tau thaum tus nqi SSl ntau dua 16.39%. Ib qho kev pom zoo thoob ntiaj teb kev pom zoo pom zoo luam tawm xyoo 2017 tau tshuaj xyuas 100 cov ntawv luam tawm los ntawm 2000 txog 2015 uas piv cov tsoos tsho hnav khaub ncaws nrog kaw -incision tsis zoo siab kho. Cov txiaj ntsig tau txhawb nqa kev siv VSD rau sutured incisions hauv cov neeg mob uas muaj kev pheej hmoo siab ntawm SSl thiab tuaj yeem txo qhov tshwm sim ntawm SSI.
Hauv pab pawg neeg soj ntsuam ntawm ntau hom kev phais, plaub observa-tshwj xeeb kev tshawb fawb ntawm lub plab phab ntsa reconstructive phais pom tau hais tias pVSD txo qhov tshwm sim ntawm SSls, whereas ib qho kev soj ntsuam kev tshawb fawb pom tau hais tias pVSD tsis muaj qhov zoo ntawm kev txo qhov tshwm sim ntawm SSls. Tsis tas li ntawd, rau qhov kev tshawb fawb soj ntsuam ntawm kev phais mob qog nqaij hlav tau pom tias pVSD txo qhov tshwm sim ntawm SSls. ib qho kev soj ntsuam kev tshawb fawb ntawm pan-creatoduodenectomy tau pom tias pVSD txo qhov tshwm sim ntawm SSls, thiab ib qho RCT ntawm ulcerative colitis ileostomy thim rov qab qhia tau tias pVSD tsis txo qhov tshwm sim ntawm SSls.A tag nrho ntawm rau RCTs tshawb xyuas ntau yam mob plab ulcerative ileostomy reversal qhia tias pVSD tsis txo qhov tshwm sim ntawm SSls.Ib tag nrho ntawm rau RCTs tshawb xyuas ntau lub plab zom mov ntawm SD cov kev phais, ntawm cov kev phais mob plab. ob pom tias pVSD tsis txo qhov tshwm sim ntawm SSls, thiab ib qho pom tau tias VSD txo qhov tshwm sim ntawm SSls, tab sis qhov sib txawv tsis tseem ceeb, Kaum ib qho kev soj ntsuam ntawm kev phais plab, nrog rau kev phais mob rau menyuam yaus.gynecological malignancy phais, phais phais, thiab daim siab transplantation V. Ib qho RCT tau pom tias pVSD txo qhov mob tom qab phais thiab qhov xav tau ntawm anes-thetics, txawm li cas los xij, txawm tias qhov tshwm sim ntawm SSls txo qis, qhov sib txawv tsis tseem ceeb.
Hais txog qib kev kis kab mob hauv cov pab pawg uas muaj ntau hom kev phais, ib qho kev tshawb fawb pom tau tias pVSD txo qhov tshwm sim ntawm SSls hauv cov kab mob sib kis, hos lwm qhov kev tshawb fawb pom tau tias pVSD tsis txo qhov tshwm sim ntawm SSls hauv cov kab mob kis kab mob.6l A tag nrho ntawm cov kev tshawb fawb nees nkaum 13 cov kev tshawb fawb soj ntsuam pom tau tias pVSD txo qhov tshwm sim ntawm SSls kom huv si - cov kab mob tsis huv, peb RCTs tau pom tias pVSD txo qhov tshwm sim SSls, thiab lwm peb RCTs qhia tias pVSD tsis muaj qhov zoo ntawm kev txo qis kev kis kab mob.
Qhov siab - qhov muaj feem cuam tshuam rau qhov pib ntawm SSls suav nrog vascular dis- xaj vim qhov raug mob ntawm cov nqaij mos peripheral, hemorrhage lossis hematoma, cov ntaub so ntswg necrotic, intraoperative contamination, lub sijhawm phais ntev, thiab rog rog, ntshav qab zib thiab haus luam yeeb.

A: Kev siv VSD nyob rau hauv cov kab mob hnyav / kis mob plab yog pom zoo, uas tuaj yeem
tiv thaiv / kho tus kab mob, ua kom ceev theem II kaw ntawm qhov txiav, thiab ua kom luv nyob hauv tsev kho mob (Qib B).
Tag nrho ntawm 26 kab lus tau suav nrog, ntawm 3 yog RCTs thiab 23 yog cov kev tshawb fawb soj ntsuam thiab cov ntaub ntawv series.
Ib qho RCT suav nrog 81 tus neeg mob kis mob hnyav tau pom tias 27 kis tau raug kaw nyob rau theem I, 29 kis tau kaw qeeb, thiab 25 kis tau thov VSD. Cov kab mob incision yog 37%, 17%, thiab 0.2%, feem. Hauv ob txoj kev tshawb fawb soj ntsuam, VSD tau siv rau qhov kev sib sib zog nqus tob tob thaum ntxov tom qab lub plab phab ntsa hernia nro- kho dawb. Ntawm 33 qhov kev kho mob nrog kev tshem tawm suture thiab VSD, muaj kev tshem tawm mesh thiab lwm yam 24 tsis tau; tag nrho cov qhov txhab kho tsis pub dhau 4 lub lis piam.
Hauv kev txheeb xyuas qhov cuam tshuam thiab muaj peev xwm ntawm VSD nyob rau hauv qhov chaw phais mob / kis mob plab, ib qho RCT tau pom tias VSD muaj kev nyab xeeb nyob rau hauv lub plab qhib (OA) tom qab hnyav intra- mob plab thiab txhim kho lub neej zoo ntawm cov neeg mob, 20 whereas RCT los ntawm Roberts et al. nyob rau theem nrab plab kab noj hniav
ity abscess tom qab kev phais tswj kev puas tsuaj tau pom tias VSD txo cov kab mob hauv lub cev. Lwm RCT los ntawm Kirk-patrick et al.71 tau qhia tias VSD tsis ua kom cov kua paug tawm los yog
txo qhov systemic inflammatory markers.
Ntau qhov kev soj ntsuam kev tshawb fawb txog kev siv VSD rau cov kab mob retroperitoneal qhov chaw sib txawv tau pom tias VSD tuaj yeem tswj tau cov kab mob hauv zos thaum ntxov, ua kom cov abscess huv si, txhawb kev tawg ntawm abscess, txo lub sij hawm kho, txo cov teeb meem hauv zos, thiab txo VSD- cuam tshuam cov teeb meem.Tao li al. paub tseeb tias VSD tiv thaiv sub- gingival kab mob tom qab hepatectomy. Hauv kev tshawb fawb ntawm 39 tus neeg mob uas muaj mob hnyav rau sab hauv- plab
Kev kis kab mob ua los ntawm Pliakos li al., VSD tau txo qis kev tuag tab sis tsis tuaj yeem txo cov kab mob hauv lub cev lossis tiv thaiv qhov tshwm sim hauv tsev kho mob- kis tau tus kab mob. Lwm ob qhov kev tshawb fawb soj ntsuam tau pom tias daim ntawv thov ntawm VSD thaum lub sij hawm mob plab mob hnyav ua rau cov kua paug thiab txhawb kev txo qis ntawm cov kab noj hniav; Yog li, granulation ntawm lub qhov txhab yog tshiab, thiab tsim ib tug residual abscess raug zam.
Hais txog cov txheej txheem ntawm kev ua ntawm indwelling VSD ntawm qhov chaw ntawm kev phais plab, nws tau pom tias VSD tuaj yeem ua kom tiav cov kua dej, ua kom cov dej ntws loj thiab cov dej ntws tawm, tiv thaiv kev txhaws, ua kom cov nqaij mos o tuaj, thiab tshem tawm qhov chaw tuag zoo. kab noj hniav. Takei et al. qhia tias cov txheej txheem ntawm kev nqis tes ua yog tias lub tshuab nqus tsev tsis tu ncua ua haujlwm tshem tawm cov dej, exudate, thiab cov paug tawm ntawm cov ntaub so ntswg edema, induced cell proliferation & matrix synthesis, thiab kho kom sai. Cov kev soj ntsuam ntxiv thiab kev sim kev tshawb fawb pom tau tias cov txheej txheem yog kev nrawm ntawm cov ntshav perfusion, txhawb nqa vascularization, thiab
Kev txhim kho ntawm kev ncig hauv zos thiab qhov tsis zoo siab ua rau txo qis hydrostatic siab ntawm cov ntaub so ntswg hauv zos edema, txo qis, thiab ua kom nrawm nrawm ntawm cov edema.Lub xeev hypoxic tshwm sim los ntawm kev tsis zoo txuas ntxiv vim VSD kuj inhibited kab mob proliferation thiab tshem tawm cov kab mob colonization thiab cov kab mob loj hlob nruab nrab.
Thaum VSD yog siv rau kev tiv thaiv thiab kev kho mob ntawm cov kab mob uas cuam tshuam nrog cov chaw phais plab, cov khoom ua npuas ncauj yuav tsum nyob rau hauv qis los yog hauv nruab nrab ntawm qhov abscess; Yog li ntawd, lub plab phab ntsa incision yuav tsum tau ua nyob rau hauv lub ze tshaj plaws cheeb tsam kom ntws cov foaming, thiab lub zos los ntshav thiab ntau heev ntawm granulation ntaub so ntswg mus rau hauv lub npuas yuav tsum tau tiv thaiv. Cov ntaub ntawv ua npuas dej thiab cov raj xa dej tau ruaj khov los ntawm cov suture los tiv thaiv kev cuam tshuam ntawm sab qhov ntawm lub raj xa dej sab nraud ntawm daim txhuam cev, uas tuaj yeem ua rau focal necrosis ntawm phab ntsa plab hnyuv. Feem ntau, cov ntaub ntawv ua npuas ncauj yuav tsum tau muab tshem tawm lossis hloov txhua hnub; tom qab ntau tshaj 9 hnub, cov ntaub so ntswg granulation tuaj yeem loj hlob mus rau hauv cov npuas dej, ua rau los ntshav thiab nyuaj rau kev tshem tawm cov npuas dej.

A: VSD raug pom zoo raws li txoj kev nyiam rau kev kaw lub plab ib ntus (TAC) thiab intra- lub plab ntim nce ntxiv nyob rau hauv cov xwm txheej xws li mob plab hnyav, kis kab mob, thiab hloov lub siab (Qib B).
Cov ncauj lus no suav nrog 20 cov lus hais txog: ib qho RCT, 93 thiab 19 yog cov kev tshawb fawb rov qab.
Rau cov neeg mob uas mob plab mob hnyav lossis mob hnyav heev - mob plab hnyuv tau txais cov txheej txheem intraperitoneal, xws li hemorrhage thiab contamination control, thawj suture ntawm lub plab phab ntsa yuav ua rau muaj qhov tshwm sim loj, xws li kev phais tsis tu ncua, ACS, mob hnyav intra- ntau yam kab mob hauv plab thiab tsis ua hauj lwm. TAC technology yog xav tau rau cov neeg mob no. TAC tuaj yeem ua rau lub plab zom mov ntau ntxiv thiab txo lub plab zom mov, zam kev ntxiv - cov kua dej intraperitoneal, rov tsim kho lub plab phab ntsa thaiv, tiv thaiv sab hauv - plab hnyuv, tiv thaiv kab mob, thiab txo qhov tshwm sim ntawm plab hnyuv fistulae.
TAC tuaj yeem siv rau hauv cov xwm txheej hauv qab no: (1) peritonitis, necrotizing fasciitis, thiab purulent mob plab; (2) mob plab, kev puas tsuaj tswj laparotomy, thiab plab phab ntsa puas; (3) mesenteric ischemia thiab cov xwm txheej thaum lub plab zom mov nyuaj los txiav txim siab vim muaj ntau yam ua rau; (4) thawj lossis theem nrab plab ntshav siab lossis ACS; thiab (5) daim siab hloov. Qhov zoo tshaj plaws, TAC yuav tsum muaj peev xwm ua kom lub plab kab noj hniav nyob rau hauv lub xeev kaw, tiv thaiv cov kab mob sab hauv ntawm lub plab kab noj hniav, tsis txhob exogenous kab mob los yog cov neeg kho tshuab raug mob, tshem tawm cov exudate los ntawm lub plab kab noj hniav, nthuav lub ntim ntawm lub plab kab noj hniav kom txo tau cov intra- plab hnyuv siab rau kev kho mob, tiv thaiv los yog kev kho mob ntawm CS. meej plab kaw nyob rau hauv lub yav tom ntej. Muaj ntau txoj hauv kev TAC, suav nrog cov tawv nqaij yooj yim kaw (lub tsho clamp lossis suture), suturing yas thiab lwm yam ntaub ntawv rau ntawm daim tawv nqaij, suture ntawm dag mesh rau lub fascia, thiab VSD- pab kaw.
Daim ntawv thov ntawm VSD- pab TAC tau dhau los ua txoj hauv kev tseem ceeb. Lub VSD system (ABCIra teeb, KCI, USA) ua tau raws li feem ntau ntawm cov kev cai ntawm TAC zoo tagnrho. Txoj kev phais yog raws li nram no: tom qab ua tiav ntawm kev phais intraperitoneal, qhov ntau dua omentum yog muab tso rau hauv qhov kev phais kom npog cov hnyuv, lined nrog nyias zaj duab xis los pab tiv thaiv adhesion ntawm txoj hnyuv thiab lub plab phab ntsa, thiab tom qab ntawd VSD ua npuas ncauj yog sutured rau lub plab zom mov hauv fascia ntawm daim tawv nqaij. Zaj duab xis npog tag nrho lub qhov txhab thiab tuav ib puag ncig kaw. Lub raj xa dej txuas nrog lub tshuab nqus tsev nqus, thiab lub siab hloov kho rau 60 kPa txog 80 kPa. Feem ntau, cov kua dej tuaj yeem txuas ntxiv rau 5-7 hnub.
Cov kua dej tsis zoo tiv thaiv kev sib sau ntawm exudates thiab inflammatory mediators nyob rau hauv lub plab kab noj hniav. Kev tso dej tsis tu ncua ua kom lub sijhawm hloov pauv hauv lub cev - cov kua hauv plab uas muaj cov kua dej hauv plab mus rau sab nraud ntawm lub cev, yog li txo qis cov tshuaj tiv thaiv kab mob hauv lub cev thiab tsim kom muaj ib puag ncig zoo rau kev rov qab los ntawm cov txiav ua puas. Txoj hauv kev no txo qis cov teebmeem corrosive ntawm cov kua dej tsis zoo ntawm cov ntaub so ntswg hauv plab hnyuv thiab plab, ua kom yooj yim ntawm cov ntaub so ntswg necrotic hauv pancreatitis, tiv thaiv lossis txo qhov qhib ntawm lub plab fascia cov ntaub so ntswg los ntawm kev ua ib leeg lossis ua ke nrog kev txhawb nqa traction ntawm lub fascia kom txo qis ntawm cov phab ntsa ntawm fascia. hernias, txo tsev kho mob- kis kab mob hauv qhov txhab, thiab pab txhawb kev kho mob tom qab-.
Hauv ib qho kev tshawb nrhiav rov qab ntawm TAC nrog 58 tus neeg mob, VSD tau siv rau hauv 27 tus neeg mob, lwm yam kev kho mob tau siv rau hauv 31 tus neeg mob ntxiv. Cov txiaj ntsig tau pom tias VSD tau zoo dua rau lwm txoj hauv kev hais txog qhov ntev ntawm lub plab qhib, qhov zaus ntawm kev hloov pauv hloov pauv, re-kev tshawb nrhiav tus nqi, qhov ua tiav ntawm kev phais plab, thiab enteroatmospheric fistula. Ib txoj kev tshawb fawb yav tom ntej ua los ntawm Perez et al.100 tau qhia tias VSD tom qab kis mob plab thiab intra- plab hnyuv siab ua rau lub sijhawm rov qab los thiab nce qhov ua tiav ntawm lub plab kaw.
Kev tshawb fawb ntawm VSD hauv 24 tus neeg mob tom qab hloov daim siab tau pom tias lub sijhawm kaw fascial thaum ntxov tuaj yeem ua luv luv rau qhov nruab nrab ntawm 5.5 hnub (1e12 hnub).56 Kev siv VSD tuaj yeem txo qhov tshwm sim ntawm cov teeb meem thiab kev tuag ntawm cov neeg mob hloov lub siab nyob rau hauv TAC.49,56,101 Ib qho kev soj ntsuam. intra- plab siab tau txo qis nrog kev siv VSD hauv cov neeg mob ACS los ntawm pancreatitis lossis ntau qhov raug mob. Ib daim ntawv tshaj tawm ntawm lub plab khoob vim mob pancreatitis tau pom tias VSD (ABThera kit, KCI, USA) tau pab aspirate ntau ntawm exudate nyob rau hauv lub plab kab noj hniav thiab pab tswj kev kis kab mob.
After TAC, the abdomen should be directly closed when patient's general condition improves, intra-abdominal inflammatory edema subsides, intra-abdominal infection is controlled within 1-2 weeks, intestinal edema is absorbed, and intra-abdominal pressure is < 12 mmHg; if the intra-abdominal pressure remains >12 mmHg tom qab 1e2 lub lis piam los yog lub plab phab ntsa tsis zoo yog tshwm sim, lub plab kaw yuav tsum tau ua los ntawm daim tawv nqaij grafting tom qab tsim cov ntaub so ntswg granulation nyob rau hauv cov ntaub ntawv ua npuas ncauj thiab tsim kom muaj kev npaj plab hnyuv hernia, ua raws li lub plab phab ntsa reconstruction nyob rau hauv 6e12 lub hlis. 70% e90% ntawm thawj theem. Kev tshuaj xyuas zoo ntawm OAs uas suav nrog 112 kab lus pom tias tus nqi ntawm
Thaum ntxov fascial txheej kaw tau nyob rau hauv ib tug nqis los ntawm 74.6%, 48%, 35%, thiab 27% nrog kev siv ntawm VSD ntxiv rau lub plab phab ntsa kaw, VSD ib leeg, tsis zoo pob, thiab Bogota lub hnab raws li.21 Ib tug retrospective txoj kev tshawb no los ntawm Sibajaet li al.on 48 cov neeg mob uas muaj kab mob intradom ntau VSD- pab OA tau nthuav tawm tus nqi siab dua ntawm kev kaw lub ntsej muag thaum ntxov, ua kom lub sijhawm ICU nyob ntev, txo kev tuag, thiab txo qis ntawm cov teeb meem cuam tshuam. Yog tias lub plab tsis tuaj yeem kaw thaum ntxov, cov teeb meem tshwm sim tuaj yeem tshwm sim, suav nrog enteroatmospheric fistula, kab mob plab kab noj hniav, plab los ntshav, thiab plab phab ntsa hernia. Qhov teeb meem nyuaj tshaj plaws yog enteroatmospheric fistula, uas muaj qhov tshwm sim ntawm 5% e75%. Ib RCT qhia tias VSD- pab TAC tsis tau
ua rau plab hnyuv fistulas, 93 thiab kev tshuaj xyuas tau qhia tias VSD zoo dua li Bogota lub hnab thiab cov txheej txheem Barker hauv kev txo cov teeb meem thiab cov kab mob.

A: Daim ntawv thov ntawm VSD tom qab o, raug mob lossis phais hauv cov kab mob hauv plab, xws li daim siab,
Cov kab mob biliary, pancreas, thiab duodenum, tuaj yeem ua kom cov kua dej txaus, tiv thaiv thiab tswj cov kab mob, thiab txhawb kev kho qhov txhab (Qib C).
Kaum ib qhov kev tshawb fawb ntawm VSD daim ntawv thov nyob rau hauv intraperitoneal kab mob o, raug mob thiab phais kev kho mob tau suav nrog, ib tug RCTand 10 soj ntsuam kev tshawb fawb.
Ib qho RCT tau pom tias muaj kev nce ntxiv hauv granulocyte membrane fluidity thiab nce kev ciaj sia nyob rau hauv cov neeg mob uas mob pancreatitis hnyav dhau los ntawm cov ntaub so ntswg necrotizing thiab VSD (p <0.041).
Ib txoj kev tshawb fawb soj ntsuam tau tshaj tawm txog qhov cuam tshuam ntawm laparoscopic VSD ntawm kev kho mob ntawm 8 tus neeg mob uas muaj tus mob pancreatitis hnyav uas tau txiav lub plab zom mov thiab 4cm × 15cm ua npuas ncauj tau muab tso rau hauv cov hnab ntim tsawg dua rau ntawm daim tawv nqaij pancreatic. Cov npuas dej tau hloov 4-7 zaug tom qab kev phais; qhov nruab nrab tso dej hauv 48 teev yog
600 mL / d thiab txo qis txhua hnub, thiab tus nqi kho tau zoo dua qub.
Ib qho kev tshawb fawb pom tau hais tias piv nrog cov kab mob hepatectomy, cov ntaub ntawv ua npuas dej tso rau ntawm lub siab qhib thiab siv VSD cov txheej txheem hauv cov neeg mob qog nqaij hlav cancer hauv lub gallbladder nrog rau cov kab mob siab metastases uas tau ua rau lub siab segmentation thiab portal leeg ligation hauv staged hepatectomy nce qhov ntim ntawm daim siab ntxiv mus rau 117% ntawm qhov qub (nce ntxiv qhov mob sab laug) thiab sab laug. kho.47 Ib qho kev soj ntsuam
tional kawm txog kev hloov pauv daim siab ua ke nrog VSD tau pom tias daim ntawv thov VSD txo qhov mob ntawm qhov txhab.49
Cov kev tshawb fawb ntawm VSD daim ntawv thov nyob rau hauv pancreatic duodenal raug mob los ntawm Huo et al.46,53,81 tau qhia tias VSD muaj kev kho mob zoo rau kev raug mob hnyav ntawm cov kab mob hauv lub cev, duodenum, thiab pancreas thiab txo cov teeb meem thiab tus kab mob. Ntxiv mus, VSD cov kua dej tuaj yeem muaj kev nyab xeeb thiab ua tau zoo dhau los ntawm jejunostomy fistula rov qab mus rau txoj hnyuv.
Rau cov neeg mob uas muaj tus mob pancreatitis lossis mob pancreatic, VSD tuaj yeem txhim kho cov kua dej kom zoo thiab muaj txiaj ntsig zoo hauv kev puas tsuaj rau pancreatic thaum ntxov yam tsis muaj tus kheej - zom; Txawm li cas los xij, cov neeg mob pancreatitis nrog tus kheej- kev zom zaub mov tuaj yeem muaj cov ntaub so ntswg necrotic txhaws cov npuas dej, thiab yog li, cov npuas dej yuav tsum tau rov ua dua.
hloov. Tsis tas li ntawd, txoj hnyuv loj feem ntau tau txhaws ua npuas ncauj vim yog hnoos qeev lossis quav, thiab yog li, VSD tsis haum rau kev raug mob plab. Intraperitoneal kev tso kawm yuav tsum ua raws li lub hauv paus ntsiab lus ntawm kev coj txoj kev luv tshaj tawm ntawm lub cev; qhov tsim nyog ntev thiab dav yuav tsum tau txiav raws li qhov xav tau, thiab tsawg kawg yog 1 cm ntawm cov khoom yuav tsum tau muab khaws cia rau sab nraum lub cev kom pab saib xyuas qhov tsis zoo siab. Txhawm rau kom tsis txhob muaj kev puas tsuaj rau txoj hnyuv, kev sib cuag ntawm cov khoom ua npuas ncauj thiab cov hnyuv suture yuav tsum tau zam los yog txo qis. Ib txoj hauv kev txhim khu kev qha yog kom luv cov khoom ua npuas ncauj kom txog li 1 cm nyob nruab nrab ntawm cov khoom ua npuas ncauj thiab cov anastomosis, los yog ntau dua omentum yuav tsum tau muab tso rau ntawm cov npuas dej thiab cov hnyuv. Kev tsis zoo siab thiab cov dej ntws tawm, xws li elasticity thiab vau ntawm cov khoom ua npuas ncauj nthuav tawm ntawm lub cev, yuav tsum tau saib xyuas kom zoo. Lub sijhawm ua kom zoo ntawm cov khoom ua npuas dej yog 4-7 hnub; lub sijhawm no tuaj yeem ua kom luv lossis txuas ntxiv nyob ntawm cov khoom ntawm cov khoom siv dej. Yog tias muaj kev cuam tshuam tshwm sim, cov khoom ua npuas dej yuav tsum tau hloov pauv, tshwj xeeb tshaj yog rau cov neeg mob pancreatitis hnyav. Intra-abdominal irrigation yog tsis pom zoo vim hais tias irrigation yog tsis synchronized nrog cov kua thiab yog li tam sim ntawd nrhiav tau ntawm cov dej tsis xws luag vim ua npuas ncauj los yog catheter blockage yog yuav luag tsis yooj yim sua; Tsis tas li ntawd, cov kua dej ntws tawm tuaj yeem nkag mus rau hauv lub plab kab noj hniav loj tom qab qhov txhaws, ua rau muaj kab mob sib kis los yog kis kab mob. Hauv kev siv tshuaj kho mob, kev siv dej tuaj yeem suav nrog cov kev txwv ntawm thaj chaw tso dej.107 Tom qab tso dej rau 48e72 h, cov kav dej patency thiab cov kua dej ntawm cov dej yuav tsum tau ua kom ntseeg tau; ib txwm saline yog pom zoo rau irrigation.

A: VSD pab txhawb kom cov kua dej txaus, tswj cov kab mob, thiab txhawb kev kho qhov txhab hauv kev kho mob enterocutaneous, enteroatmospheric, thiab pancreatic fistulas (Qib B).
Tag nrho ntawm 22 cov kev tshawb fawb tau suav nrog, ib qho RCT, 110 ib qho kev tshuaj xyuas, 111 thiab 20 kev tshawb fawb soj ntsuam.
Cov plab hnyuv fistulas suav nrog enterocutaneous fistulas (ECFs) thiab enteroatmospheric fistulas (EAFs). Hauv plab hnyuv fistulas, VSD tuaj yeem siv los ua lub qhov ncauj fistula lossis ib puag ncig lub qhov txhab txhawm rau txo cov fistula exudates, tswj cov kab mob thib ob, thiab txhim kho kev kho mob. Hauv kev tshawb fawb pab pawg ntawm kev kho mob VSD thiab pVSD, ob txoj kev tshawb fawb pom tau tias kev kho mob VSD txo qis kev yaig ntawm cov ntaub so ntswg ib puag ncig los ntawm kev zom cov kua txiv hmab txiv ntoo, zam cov kab mob thib ob, thiab txhawb txoj hnyuv fistula kaw. Polyvinyl cawv dawb ua npuas ncauj thiab intubation lub tshuab nqus tsev nqus txoj kev raug pom zoo.79,99 Muaj cov ntaub ntawv qhia txog kev siv polyurethane dub ua npuas ncauj rau kev kho mob ntawm plab hnyuv fistulas, nrog ncaj sealing, tag nrho cov kev pab them nqi, thiab tas li tso kua dej ntawm lub suction khob. Tsib qhov kev tshawb fawb soj ntsuam pom tau hais tias daim ntawv thov ntawm polyurethane dub ua npuas ncauj txo fistula exudate, txhim kho qhov txhab zoo, thiab ua kom lub plab hnyuv kaw. VSD tuaj yeem siv los ua ib qho kev ntsuas ua ntej ib ntus hauv plab hnyuv fistulas kom cais cov qhov txhab thiab plab hnyuv fistulas nrog polyurethane ua npuas ncauj hnav khaub ncaws. Ib qho RCT tau pom tias VSD tau nce qhov kev kaw ntawm fistulas.110 Ib rooj plaub-tswj kev tshawb fawb tau siv VSD hauv 16 tus neeg mob ntawm plab hnyuv fistula thiab pom tias VSD tau nrawm kho cov hnyuv fistulas piv nrog cov txheej txheem ib txwm muaj (8 kis). Yim qhov kev soj ntsuam tau pom tias VSD tuaj yeem ua tau
tswj fistula exudates, txhim kho qhov txhab zoo, thiab ua kom muaj kev vam meej ntawm txoj hnyuv fistula kho.111e118
Hauv ib qho kev soj ntsuam, 12 tus neeg mob plab hnyuv siab tau kho nrog VSD. Thaum kawg, txhua tus neeg mob tau kho tus kheej, nrog lub sijhawm kho qhov nruab nrab ntawm 45.3 hnub.119 Magalini li al. tau tshaj tawm tias kev siv lub siab tsis zoo kaw thiab cov kua dej ua tiav tau txhawb nqa tus kheej - kho rau peb kis ntawm duodenal fistula thiab zam kev rov ua haujlwm dua. Pepe et al. qhia txog kev kho mob zoo ntawm plaub qhov mob ntawm plab hnyuv fistula siv qhov tsis zoo siab kaw. Boulanger et al. tshaj tawm hais tias ib rooj plaub ntawm plab hnyuv fistula tau zoo kho tom qab tsis zoo kaw. Lwm qhov xwm txheej qhia tau hais tias kev siv qhov tsis zoo siab kaw thiab tso dej hauv qhov txhab ntawm qhov txhab ntawm peb qhov mob ntawm ntau lub plab hnyuv fistulas tau yooj yim tswj cov plab hnyuv fistulas thiab txhawb kev loj hlob ntawm cov ntaub so ntswg ntawm lub qhov txhab, yog li tsim cov xwm txheej rau qhov tseeb digestive ib ntsuj av thiab lub plab phab ntsa reconstruction. Ib qho kev soj ntsuam tau pom tias yuav tsum muaj kev tshawb fawb ntxiv los ntsuas lub luag haujlwm ntawm VSD.
Ib qho kev tshuaj xyuas cov ntaub ntawv rov qab tau suav nrog 10 kab lus nrog tag nrho ntawm 151 ECF cov neeg mob thiab pom tias dhau 58 (12-90) hnub, qhov nruab nrab kho tus nqi ntawm VSD yog 64.6% (7.7%-100%).111 Hauv Bobkiewicz txoj kev tshawb fawb ntawm cov neeg mob VSD txoj kev kho thiab lwm 8 tab tom ua kev kho mob niaj hnub raug muab piv. Cov txiaj ntsig tau pom tias qhov zaus ntawm kev hloov khaub ncaws, lub sijhawm kho, cov nqi kho mob, thiab lub sijhawm xav tau rau lub cev kub kom rov qab mus rau qhov qub, lub sijhawm pib ntawm kev noj zaub mov zoo, thiab qhov tshwm sim ntawm cov teeb meem cuam tshuam txog theem nrab tau qis dua hauv pawg VSD dua li hauv pawg tswj hwm. Kev tswj xyuas los ntawm Boulanger li al. tau tshawb xyuas 18 qhov xwm txheej ntawm enteroatmospheric fistula tab tom ua dej tsis tu ncua thiab cov dej tsis zoo uas siv tus kheej - ua ob lub raj xa dej thiab 20 tus neeg mob ntawm ECF ua rau lub qhov txhab txhaws siv tus kheej ua cov kua dej los yog VSD ntawm lub fistula qhib. Cov txiaj ntsig tau pom tias qhov txhab txhaws uas siv cov khaub ncaws ua rau tus kheej los yog VSD ntawm lub fistula qhib ua rau lub sijhawm rau ECF qhov txhab kho, txo qhov zaus ntawm kev hloov khaub ncaws, thiab txo lub sijhawm mus pw hauv tsev kho mob.
Kev kho mob ntawm lub plab plab nrog ib qho enteroatmospheric fistula yog qhov nyuaj heev. VSD tau tshaj tawm tias muaj ntau yam zoo rau kev kho mob ntawm enteroatmospheric fistulas. Hais txog kev kawm txog kev cais tawm rau enteroatmo-spheric fistulas, plaub txoj kev tshawb fawb pom tau tias VAC tuaj yeem ua ke nrog "ntiv nplhaib"/"silo", lub nplhaib log tsheb, lossis txoj kev pacifier kom cais cov qhov txhab thiab plab hnyuv fistulas.5
VSD tsis pom zoo rau kev tiv thaiv thiab kho cov kab mob colonic fistulas vim tias txoj hnyuv loj secretes mucus, uas tuaj yeem thaiv cov khoom ua npuas ncauj thiab ua rau cov kua dej tsis zoo.

A: Kev siv VSD cov txheej txheem rau kev kho mob ntawm sab hauv- plab hnyuv thiab extraperitoneal abscesses ua kom cov kua dej txaus, tswj kev kis kab mob, thiab txhawb kev kho qhov txhab (Qib C).
Tag nrho ntawm 6 cov kev tshawb fawb soj ntsuam tau suav nrog.
Kev cuam tshuam thiab muaj peev xwm ntawm VSD rau kev mob hnyav heev - mob plab thiab plab abscesses tshwm sim los ntawm tus mob pancreatitis hnyav lossis perforation ntawm plab hnyuv tau raug tshuaj xyuas. Xav berg et al. qhia tias VSD muaj kev nyab xeeb rau OA thaum muaj mob hnyav rau hauv - mob plab thiab txhim kho tus neeg mob lub neej zoo. Ruiz-Lopez li al pom tias VSD tom qab kis mob plab thiab/los yog mob plab plab ua rau lub sijhawm rov qab los thiab nce qhov ua tiav ntawm lub plab kaw. Tsis tas li ntawd, Kirkpatrick et al.71 tau qhia tias VSD tsis ua kom cov kua paug tawm los yog txo cov kab mob hauv lub cev.
Hais txog cov txiaj ntsig ntawm VSD hauv cov xwm txheej nyuaj nrog cov kab mob sib txawv, kev soj ntsuam kev tshawb fawb ntawm VSD rau postperforation abscesses hauv diverticulitis tau ua pov thawj tias VSD txo qis kev tuag thiab tus nqi mus tas li ntawm txoj hnyuv ostomy. Lwm qhov kev soj ntsuam kev tshawb fawb ntawm pancreatic abscesses los ntawm Olejniket thiab al.qhia tias VSD txo kev tuag thiab lwm yam teeb meem. Kev tshawb nrhiav rov qab ntawm VSD nyob rau hauv intraperitoneal abscesses nrog ntau yam ua rau pom tau tias qhov tshwm sim ntawm VSD- cuam tshuam txog cov teeb meem thiab tus nqi ntawm lub plab kaw hauv theem kuv tau nce. Txawm li cas los xij, cov txiaj ntsig rau lwm pab pawg yuav tsum tau tshawb xyuas ntxiv.

A: VSD tuaj yeem siv rau kev kho mob hauv plab, qhov txhab ntawm lub qhov txhab, thiab qhov tsis xws luag nrog ntau yam ua rau thiab tuaj yeem ua kom cov kua dej txaus, tswj cov kab mob, txhawb nqa granulation cov ntaub so ntswg hyperplasia thiab qhov txhab kho, thiab txo lub sijhawm kho (Qib C).
Tag nrho ntawm 14 kab lus tau suav nrog, ntawm 12 yog cov kev tshawb fawb soj ntsuam thiab 2 yog kev sim tsiaj
kev kawm.
VSD tuaj yeem siv rau kev kho mob ntawm lub plab phab ntsa uas muaj qhov sib txawv. Kev kis kab mob -vim lub plab phab ntsa tsis xws luag tuaj yeem kho nrog cov kua dej tsis zoo; ib qho kev soj ntsuam kev tshawb fawb ntawm cov kab mob hauv plab plab, necrotizing fasciitis, thiab plab phab ntsa tsis xws luag tshwm sim los ntawm lub plab phab ntsa liposuction tau pom tias kev siv VSD txhawb nqa cov ntaub so ntswg necrotic, tswj kev kis kab mob, txhawb nqa granulation, thiab pab txhawb kev txhim kho thaum ntxov ntawm lub plab zom mov. Kev puas tsuaj rau lub plab phab ntsa tuaj yeem kho nrog lub siab tsis zoo
kua dej; Ob qhov kev sim tsiaj tau tshawb xyuas cov kab mob plab plab uas tshwm sim los ntawm kev tawg thiab pom tias daim ntawv thov ntawm VSD thaum ntxov TAC tau zoo tiv thaiv lub cev raug mob, tiv thaiv qhov xav tau rau lub plab hnyuv fistula, txo qhov mob thiab plab kab mob, txo lub sij hawm npaj ua ntej,
txo tus naj npawb ntawm kev hloov khaub ncaws, thiab ua kom yooj yim kaw thaum ntxov ntawm lub plab kab noj hniav.
Ob peb lub ntsiab lus tseem ceeb yuav tsum tau txiav txim siab rau kev siv VSD rau cov kab mob plab plab. Chen et al.133 tau hais qhia ncaj qha txog kev hnav khaub ncaws VSD rau ntawm lub plab hnyuv thiab tam sim ntawm daim tawv nqaij grafting tom qab tsim granulation. Thaum Aydin et al. txhawb kev sib cuag nrog cov hnyuv thiab pom zoo kom siv ntau dua omentum los yog cov khoom siv hluavtaws (xws li silica gel mesh) los thaiv cov hnyuv thiab hnav khaub ncaws. Tom qab ntawd cov kua dej tsis zoo yog siv los txhawb granulation. Ib qho kev soj ntsuam kev tshawb fawb tau xaus lus tias kev sib cuag ncaj qha ntawm kev hnav khaub ncaws nrog txoj hnyuv muaj kev pheej hmoo ua rau lub plab hnyuv fistula.130 Hais txog qhov tsis zoo ntawm cov phab ntsa hauv plab, rau qhov kev soj ntsuam pom pom zoo tias qhov siab tsis zoo yuav tsum nyob ntawm thaj tsam ntawm 70-100 mmHg.
VSD yog ua nyob rau hauv cov theem kho ntawm lub plab phab ntsa tsis xws luag. Peb qhov kev soj ntsuam kev tshawb fawb tau pom tias VSD tuaj yeem siv ua ke nrog kev kho qhov tsis xws luag siv cov khoom siv hluavtaws (absorbable lossis tsis yog -absorbable) lossis hloov pauv thiab tawv nqaij graft thaum kho thiab rov tsim kho cov kab mob hauv plab, uas tuaj yeem ua rau muaj sia nyob thiab ua kom lub sijhawm kho.

A: Kev sib cuag ncaj qha ntawm VSD foams nrog cov hlab ntsha yuav tsum zam. Kev siv cov spacers nrog tus kheej - cov ntaub so ntswg lossis cov khoom siv dag zog tau pom zoo thiab kev soj ntsuam ze ntawm cov dej ntws tsis zoo (Qib C).
Tag nrho ntawm 8 cov kev tshawb fawb soj ntsuam tau suav nrog.Txawm tias cov khoom siv PU muaj qhov pore loj thiab muaj peev xwm ua rau cov hlab ntsha raug mob thiab ua rau hemorrhage, vascular teeb meem tshwm sim los ntawm VSD tsis tshua muaj nyob rau hauv kev kho mob. Los ntshav feem ntau tshwm sim los ntawm kev los ntshav los ntawm cov ntaub so ntswg tshiab, tab sis qeeb hemorrhage vim vascular phab ntsa yaig tom qab vascular raug mob yog qhov zoo heev. Los ntshav tom qab VSD feem ntau yog vim yog ob qho xwm txheej: coagulation tsis ua haujlwm thiab tso VSD cov khoom ncaj qha rau ntawm lub plawv lossis cov hlab ntsha, tshwj xeeb tshaj yog cov ntshav.
cov hlab ntsha tom qab anastomosis, los ntawm qhov nqus tau tuaj yeem thaiv cov hlab ntsha nyias nyias thiab ua rau los ntshav.137 Kev tshawb fawb soj ntsuam tau pom tias muaj ntau yam hemorrhages tshwm sim tom qab kev kho VSD hauv cov neeg mob uas muaj vascular anastomosis. Txhawm rau tiv thaiv kom tsis txhob los ntshav, yuav tsum tau muab tso rau ntawm cov khoom siv dag zog ntawm cov kua dej thiab cov npuas dej kom tsis txhob cuam tshuam rau qhov txhab ntawm qhov txhab thiab nqus cov exudates. Cov ntshav los ntshav ntawm lub aorta tom qab siv VSD rau qhov kev txiav sternotomy tau pom nyob rau qee kis, qhia tias tawg.
fragments ntawm lub qhov txhab yuav tsum tau muab tshem tawm ua ntej siv lub siab tsis zoo. Ib txoj kev tshawb fawb kuj tau pom tias VSD cov cuab yeej thaiv yuav ua rau cov ntshav tawm. Kev tshawb nrhiav rov qab rau 16 tus neeg mob uas muaj tus kab mob sib sib zog nqus tau pom ob qhov kev los ntshav cuam tshuam nrog kev tsis zoo txuas ntxiv tom qab kev phais.

A: Thaum siv VSD, kev pheej hmoo ntawm cov hnyuv raug mob yuav tsum tau saib xyuas (Qib B).
Tag nrho ntawm 19 kab lus hais txog VSD- ntsig txog kev raug mob plab hnyuv thib ob tom qab phais plab tau suav nrog, ntawm 2 yog RCTs thiab 17 yog cov kev tshawb fawb rov qab.
Txawm hais tias kev siv VSD tom qab phais plab tuaj yeem ua rau mob plab hnyuv thib ob thiab ua rau muaj qhov tshwm sim ntawm plab hnyuv fistulas muaj teeb meem. Tam sim no, kev tshawb fawb ntau ntxiv tau lees paub tias kev siv VSD tsis nce qhov tshwm sim ntawm plab hnyuv fistulas.
Rau cov neeg mob uas tsis muaj plab hnyuv fistula ua ntej kev phais, qhov tshwm sim ntawm plab hnyuv fistula yog 1.6% e37% tom qab VSD- pab TAC. Hauv cov kev tshawb fawb yav tom ntej, ob lub RCTs piv qhov tshwm sim ntawm plab hnyuv fistulas hauv TAC phais siv VSD thiab absorbable mesh tsau ntawm lub plab fascia thiab pom tsis muaj qhov sib txawv tseem ceeb. Ntawm tsib qhov kev tshawb fawb soj ntsuam, Plaudis li al. thov VSD rau kev kho mob ntawm ACS thiab
peritonitis nyob rau hauv 22 tus neeg mob, uas peb muaj plab hnyuv fistulas. Navsari et al.148 tau kho 20 tus neeg mob plab mob nrog VSD tom qab kev phais, ntawm ib tus tau tshwm sim hauv plab hnyuv fistula thib ob thiab ib tus muaj plab hnyuv necrosis. Rao et al. thov VSD hauv 29 tus neeg mob tom qab phais plab thiab ntsib 6 tus neeg mob plab hnyuv fistulas.
Txawm li cas los xij, hauv kev tshawb nrhiav yav tom ntej ntawm 578 tus neeg mob uas tau phais plab, Carlson et al.found tias kev siv VSD tsis ua rau muaj qhov tshwm sim ntawm plab hnyuv fistulas lossis plab hnyuv tsis txaus; piv txwv hauv txoj kev tshawb no suav nrog tag nrho ntawm 187 khub ntawm cov neeg mob thiab cov kev soj ntsuam tau qhia tib yam. Hauv kev tshawb nrhiav yav tom ntej los tshuaj xyuas cov txiaj ntsig kev kho mob cuam tshuam nrog kev kho mob lub qhov txhab tsis zoo thiab Barker lub tshuab nqus tsev nqus tau ua los ntawm Cheatham li al.,153 280 cov neeg mob
kev phais plab tau suav nrog; 178 tau kho nrog VSD, ntawm 13 muaj mob plab hnyuv ischemic necrosis, 7 plab hnyuv fistulas, thiab 5 plab hnyuv. Ntawm 102
Cov neeg mob tau kho nrog Barker lub tshuab nqus tsev- cov txheej txheem ntim khoom, 3 muaj lub plab zom mov ischemic necrosis, 4 lub plab hnyuv fistulas, thiab tsis muaj plab hnyuv. Cov txiaj ntsig ntawm kev siv VSD thiab Barker lub tshuab nqus tsev- cov txheej txheem ntim khoom tsis txawv txav. Kleif et al. pom tias kev siv VSD ua ke nrog mesh-foilmediated kaw txo qhov tshwm sim ntawm plab hnyuv fistulas. Hauv kev tshawb nrhiav rov qab ntawm 108 tus neeg mob uas tau txais kev kho mob phais mob loj heev diffuse peritonitis, Mutafchiyski et al.146 pom tias qhov tshwm sim ntawm plab hnyuv fistulas hauv cov pab pawg tau kho nrog VSD pab TAC thiab mesh-foil laparostomy yog feem ntau 19%, tab sis tsis muaj txiaj ntsig. Hauv lwm ob txoj kev tshawb fawb los ntawm Bee et al.and Carlson et al., qhov tshwm sim ntawm plab hnyuv fistulas tom qab VSD yog siab dua li ntawm cov mesh -cov pab pawg neeg foil, tab sis qhov txawv tsis tseem ceeb.
Tsib qhov kev tshawb fawb soj ntsuam tau pom tias OA qhov tsis zoo ntawm lub qhov txhab kho qhov txhab tsis ua rau muaj qhov tshwm sim ntawm plab hnyuv fistulas. Shaikh et al. tau soj ntsuam 42 tus neeg mob ntawm kev kho VSD rau plab hnyuv dehiscence thiab OA tshaj 5 xyoos. Cov txiaj ntsig tau pom tias cov txheej txheem VSD muaj kev nyab xeeb thiab tsis muaj
ncaj qha correlation nrog qhov tshwm sim ntawm plab hnyuv fistulas. Hauv kev tshawb nrhiav rov qab ua los ntawm Fieger etal., cov neeg mob uas lub plab qhib tau txais kev kho mob VSD, 16 muaj plab hnyuv fistulas. Ib yam li ntawd, Bjorck et al. € 98 qhia tau tias tsis muaj qhov sib txawv ntawm qhov tshwm sim ntawm plab hnyuv fistulas ntawm cov pab pawg siv VSD thiab pab pawg siv mesh-kev kho mob fascial traction rau TAC tom qab phais plab. Kev tshawb nrhiav rov qab ua los ntawm Mintziras et al.of 43 cov neeg mob uas muaj mob peritonitis thib ob kho nrog VSD tom qab- ua haujlwm, 16 tsim cov plab hnyuv fistulas thiab cov neeg txais kev ua haujlwm nkhaus (ROC) tsom xam pom tias kev kho VSD
txo qhov tshwm sim ntawm plab hnyuv fistulas thaum lub sijhawm thov tsawg dua 13 hnub. Hauv kev tshawb nrhiav ob npaug ntawm -centre retrospective txoj kev tshawb fawb ntawm 81 cov neeg mob uas tau laparotomy ua los ntawm Acosta li al.,1 cov txiaj ntsig tau pom tsis muaj kev sib raug zoo ntawm txoj hnyuv fistula tsim thiab kev kho VSD. Tsis tas li ntawd, kev tshawb fawb rov qab los ntawm Montori li al. tsis pom qhov sib txawv ntawm qhov tshwm sim ntawm plab hnyuv fistulas ntawm kev siv VSD thiab hloov pauv Barker tsis zoo siab pob tom qab phais plab.
Mechanisms ntawm plab hnyuv raug mob thib ob rau plab VSD muaj xws li hauv qab no. (1) Kev raug mob nrog rau lub plab lossis cov kab mob hauv lub cev hloov pauv, suav nrog peritonitis & diverticulitis, 85 mesenteric ischemia, arterial blood lactate ntau dua li cov plab hnyuv siab tsis txaus, pancreatic necrosis, thiab diverticulitis.34,145,154 (2) Kev mob ntshav qab zib tsis zoo. Ob qhov kev tshawb fawb soj ntsuam pom tau hais tias qhov tsis zoo siab tus nqi ntawm 17 kPa (125 mmHg) muaj cov kua dej zoo heev thiab ua rau muaj kev puas tsuaj me me rau cov hnyuv me.8,17 Ib qho kev soj ntsuam pom tau hais tias qhov tsis zoo siab ntawm 6.7 kPa mus rau 22.6 kPa (50 mmHg txog 170 mmHg) hauv cov ntshav tau txo qis hauv cov ntshav kom txo qis hauv cov ntshav. correlated nrog qhov tsis zoo siab qhov tseem ceeb.Ob kev soj ntsuam Cov kev tshawb fawb pom tau tias 10.6 kPa (80 mmHg) yog qhov pom kev tsis zoo rau cov ntshav perfusion thiab cell loj hlob 23,24; Txawm li cas los xij, qhov teeb tsa ntawm tus nqi tsis zoo yuav tsum tau tshawb xyuas ntxiv. (3) Kev raug mob los ntawm kev txhawb nqa ncaj qha ntawm cov ntaub ntawv ua npuas ncauj, uas yog txuam nrog kev siv ntev ntev ntawm VSD thiab nquag hloov.55 Ob txoj kev tshawb fawb tau pom tias trimming cov npuas dej mus txog li 1 cm los ntawm anastomosis, tso qhov ntau dua omentum ntawm cov npuas dej thiab cov hnyuv, thov hydrocolloid Ag hnav khaub ncaws, thiab qhib cov yeeb yaj kiab los yog cov ntaub pua plag. Bogota hnab) tuaj yeem txo qhov mob plab hnyuv hemorrhagic.

A: Thaum siv VSD, qhov tshwm sim ntawm peritoneal adhesions yuav tsum tau saib xyuas. Thaum twg
thov VSD- pab TAC, tso cov yeeb yaj kiab yas ntawm txoj hnyuv thiab lub plab phab ntsa pab txo cov adhesions thiab txhim kho kev kaw lub fascia thaum ntxov (Qib C).
Tag nrho ntawm 9 kab lus tau suav nrog, nrog yim qhov kev tshawb fawb rov qab thiab ib tus kws tshaj lij pom zoo.168
Cov plab hnyuv adhesion yog ib qho teeb meem tom qab phais plab, nrog rau qhov tshwm sim txog li 90% 169e173.
Peritoneal adhesion feem ntau yog hais txog qhov txawv txav ntawm txoj hnyuv, nruab nrab ntawm txoj hnyuv thiab lub peritoneum, los yog nruab nrab ntawm txoj hnyuv thiab intra- plab hnyuv kab mob.Pathological yam, xws li peritoneal o, neeg kho tshuab raug mob, cov ntaub so ntswg ischemia, thiab txawv teb chaws lub cev implantation ntawm peritoneum, yuav ua rau peritoneal o ntawm lub plab. peritoneal adhesions.Qhov cuam tshuam ntawm intraperitoneal daim ntawv thov VSD ntawm kev tsim ntawm peritoneal adhesions tsis tau tsim. Ib qho kev soj ntsuam kev tshawb fawb los ntawm Magalini li al. tau hais tias kev siv VSD los txhim kho cov kua dej ntawm plab hnyuv fistulas tuaj yeem txo qhov ntau thiab tsawg ntawm cov hnyuv adhesion thiab pab txhawb kev phais tom ntej.
Hauv kev phais OA rau kev kho cov kab mob xws li ACS, kev siv VSD-pab TAC thev naus laus zis tuaj yeem txo qhov siab hauv plab, tab sis tsis tuaj yeem zam qhov tsim ntawm adhesions. Txoj hnyuv adhesions thiab fascia retraction tuaj yeem tshwm sim nrog lub sijhawm ntev ntawm lub plab qhib; Yog hais tias lub plab phab ntsa tsis tuaj yeem raug kaw thaum ntxov, daim tawv nqaij grafting yuav tsum tau ua nyob rau sab saum toj ntawm cov ntaub so ntswg granulation, tsim kom muaj lub plab plab hernia.Kev pom zoo ntawm qhov qhib plab hauv kev raug mob 2016 pom zoo kom siv ib txheej ntawm polypropylene.
yas zaj duab xis nruab nrab ntawm VSD thiab intra- plab hnyuv siab raum kom txo tau qhov tshwm sim ntawm plab hnyuv adhesion, yog li pab txhawb fascial kaw thiab txo qhov tshwm sim ntawm lwm yam teeb meem.