重症急性胰腺炎并发腹腔室隔综合征的诊断和治疗及分型的探讨

Diagnosis and treatment of abdominal compartment syndrome in patients with severe acute pancreatitis

目的总结重症急性胰腺炎 (SAP)并发腹腔室隔综合征 (ACS)的诊断和治疗经验。方法患者高度腹胀后出现继发性心、肺、肾功能不全 ,即诊断为ACS ;CT测量腹膜后前后径 (R) /腹腔前后径 (A) <0 5归为Ⅰ型 (腹腔型 ) ,R/A >0 8为Ⅱ型 (腹膜后型 ) ,Ⅲ型为混合型。手术治疗者均用 3升静脉营养袋 (3L袋 )暂时性关腹 ,等待二期关腹。结果本组 34例 (36例次 )ACS手术死亡率为 13% (3/ 2 4 ) ,非手术死亡率为 4 2 % (5 / 12 )。Ⅰ～Ⅲ型手术与非手术死亡率分别为 0、2 0 %、17%与17%、6 7%、6 7%。结论ACS是SAP的严重合并症 ,诊断明确时应尽早手术 ,探查术后可以用 3L营养袋行暂时性关腹。

Objective To summarize the experience on the diagnosis and treatment of abdominal compartment syndrome (ACS) during the course of severe acute pancreatitis (SAP). Methods A diagnosis of ACS is established in SAP patients with cardio-pulmonary-renal disfunction secondary to severe abdominal distension after initial fluid resuscitation. Under CT measurement the ratio of retroperitoneal anteposterior diameter (R) over abdominal cavity anteposterior diameter (A),ie R/A<0.5 is characteristic of type Ⅰ ACS,that of R/A>0.8 is of type Ⅱ ACS. The remaining ACS is of mixed type. Temporary closure of abdominal cavity in ACS patients undergoing decompressive laparotomy with a 3 liter sterile plastic bag clinically used for intravenous nutrition support was performed. Results Twenty four out of 36 ACS patients underwent decompressive celiotomy with a mortality of 13%(3 cases). The mortality for the 12 cases treated by conservative therapy was 42%(5 cases). The type-specific mortality of operative and conservative therapy was 0% vs 17% (type Ⅰ),20% vs 67% (type Ⅱ),and 17% vs 67% (mixed type).The secondary abdominal closure was usually carried out 3 to 5 days after initial decompressive celiotomy. Conclusions ACS can be regarded as a severe complication of SAP. Once a diagnosis of ACS is established the patient should undergo early decompressive celiotomy and the abdominal cavity should be temporily closed with material such as 3 L sterile plastic bag.