重症急性胰腺炎并发腹腔室隔综合征的急症处理

THE EMERGENCY MANAGEMENT OF SEVERE ACUTE PANCREATITIS COMPLICATED ABDOMINAL COMPARTMENT SYNDROME

目的 探讨重症急性胰腺炎 (SAP)并发腹腔室隔综合征 (ACS)的诊断和急症处理。方法 对我院 2 0 0 0年 10月～ 2 0 0 4年 10月收治的 13例 SAP并发 ACS的临床资料进行回顾性分析。结果 本组 13例 ACS患者 ,9例 (6 9.2 % )发生在SAP急性反应期 (即早发性 ACS) ,3例 (2 3.1% )发生在 SAP感染期 (即迟发性 ACS) ,1例 (7.7% )发生在 SAP急性反应期和感染期 (即混合性 ACS)。 9例早发性 ACS中 ,1例 (7.7% )行短时血液滤过 ,2例 (15 .4 % )行左、右下腹部小切口灌洗引流术 ,3例 (2 3.1% )行腹腔镜灌洗引流术 ,3例 (2 3.1% )行开腹减压术 ;3例 (2 3.1% )迟发性 ACS均行开腹减压术 ;1例 (7.7% )混合性 ACS早期行腹腔镜灌洗引流术 ,后期行开腹减压术。治愈 7例 (5 3.8% ) ,死亡 6例 (4 6 .2 % )。结论 ACS是 SAP的严重并发症 ,死亡率极高。早期、及时的诊断与根据不同 ACS类型采取的个体化综合治疗是改善

Objective To investigate the experience of diagnosis and emergency mamagement of severe acute pancreatitis(SAP) complicated abdominal compartment syndrome(ACS).Methods Thirteen patients with SAP complicated ACS treated in our hospital from Oct,2000 to Oct,2004 were analyzed retrospectively.Results Among 13 cases, 9 cases(69.3%) of ACS occurred during the period of acute reaction(namely early ACS), 3 cases(23.1%) occurred during the period of secondary infection(namely delayed ACS),1 case occurred during the period of both acute reaction and secondary infection(namely mixed ACS). Among 9 cases of early ACS, 1 case(7.7%) received short veno-venuous hemofiltration,2 cases(15.4%) received bilateral hypogastric mini-incision lavaged and drainage,3 cases(23.1%) received laparoscopic peritoneal lavaged and drainage,3 cases(23.1%) received decompressive celiotomy;3 cases(23.1%) complicated with delayed ACS all received decompressive celiotomy;1 case(7.7%) complicated with mixed ACS received laparoscopic peritoneal lavaged and drainage in the early stage and decompressive celiotomy in the late stage. 7 cases (53.2%) were cured, and 6 cases(46.2%) died. Conclusion ACS is a serious complication of SAP and has a high mortality. Early and correct diagnosis associated with individualized combined therapies according to different types of ACS is vital to improve the prognosis.