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DOI: 10.1055/s-2006-921395
© Georg Thieme Verlag Stuttgart · New York
Möglichkeiten der Vakuumtherapie bei der Behandlung des septischen Abdomens
Possibilities of Vacuum Therapy for the Management of the Septic AbdomenPublication History
Publication Date:
03 February 2006 (online)
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Zusammenfassung
Die Fortschritte in der Intensivmedizin haben wesentlich dazu beigetragen, die Mortalität der diffusen sekundären Peritonitis zu senken. Große Probleme bei der Versorgung des Patienten mit septischem Abdomen stellen jedoch nach wie vor der nicht sanierbare septische Fokus, der temporäre Bauchdeckenverschluss, die Komplikationen im Rahmen von Re-Laparotomien sowie die Sanierung der Bauchdecke bei ausgedehnten Weichteilinfektionen, Bauchwandverlust oder persistierenden enteralen Fisteln dar. Das aus der Behandlung offener Wunden bekannte Verfahren der Vakuumtherapie wird zunehmend auch zur Therapie von septischen Prozessen in verschiedenen Regionen des Körpers eingesetzt. Insbesondere die hervorragenden Drainageeigenschaften lassen die Vakuumtherapie als eine Therapieoption zur Beherrschung chirurgisch nicht sanierbarer septischer Prozesse in der Bauchhöhle erscheinen. Der erfolgreiche Einsatz zur Therapie von enterokutanen Dünndarm- und Pankreasfisteln sowie Anastomoseninsuffizienzen am Rektum ist beschrieben. Die Anwendung der Vakuumtherapie für den temporären Bauchdeckenverschluss beim Laparostoma lässt hoffen, die bei der Versorgung von Traumapatienten aufgezeigten Eigenschaften und Studienergebnisse auf die Versorgung von Patienten mit persistierender Peritonitis übertragen zu können. Zusätzlich könnten auch diese Patienten von den Drainageeigenschaften der Vakuumtherapie profitieren. Evidenzbasierte Empfehlungen für die Anwendung der Vakuumtherapie zur Therapie des septischen Abdomens gibt es jedoch bisher kaum.
Abstract
Progress in intensive care medicine contributed substantially in lowering the mortality rate of patients suffering from diffuse secondary peritonitis. However, the greatest problems in the medical care of patients presenting a septic abdomen consist of a persisting septic focus, temporary closure of the abdomen, complications due to re-laparotomies, healing of the abdominal wall after soft tissue infection, loss of abdominal wall musculature, or persisting enteral fistulas. The method of vacuum therapy, well known from chronic wound treatment, is used with more and more frequency for the treatment of septic complications in different areas of the body. In particular the excellent drainage characteristics let this vacuum therapy appear to be a therapy option for the control of surgically untreatable septic processes in the abdominal cavity. The successful treatment by this method of enterocutaneous fistulas, small intestine and pancreatic fistulas as well as anastomotic leakage after rectal surgery is described. The application of vacuum therapy for temporary closure of open abdomen of trauma patients gives hope that the characteristics and study results can be transferred to the treatment modalities of persisting peritonitis. Additionally, these patients could profit from the drainage characteristics of the vacuum therapy. However, there exist hardly any evidence-based recommendations for the application of vacuum therapy for treatment of the septic abdomen.
Schlüsselwörter
Peritonitis - Vakuumtherapie - offenes Abdomen - Vakuumassistierter Wundverschluss
Key words
Peritonitis - vacuum therapy - open abdomen - vacuum assisted closure
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Dr. R. Weidenhagen
Chirurgische Klinik und Poliklinik · Klinikum Großhadern · Ludwig-Maximilians-Universität München
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