腹腔间室综合征13例临床分析

Clinical study of abdominal compartment syndrome in 13 cases

目的 分析腹腔间室综合征（ACS）的发病特点，总结ACS的诊断和治疗经验。方法 回顾性分析1999年4月-2004年2月收治的13例ACS病人，其中男9例，女4例。重症急性胰腺炎4例，结肠癌并急性肠梗阻急诊手术一期肠吻合3例，腹膜后血肿2例，肠系膜血管栓塞2例，肝硬化脾肿大并脾功能亢进1例，急性化脓性胆管炎1例。13例中3例采用保守治疗，手术治疗10例。保守治疗中采用气道开放、呼吸机支持2例，床旁持续血液净化1例。手术治疗中采用剖腹探查、腹腔及腹膜后引流、切口减张缝合8例，腹腔探查引流后切口采用聚丙烯网片缝合覆盖、腹腔暂时开放2例。结果 6例痊愈，7例死亡。结论 外科危重病人中并发ACS的病人病死率高，早期诊断、及时腹腔减压是改善预后、降低死亡率的关键。

Objective To analyse the clinical characteristics of abdominal and summarize some experiences in diagnosis and treatment of ACS. Methods compartment syndrome （ ACS ） 13 cases with abdominal compartment syndrome（ACS） from april 1999 to february 2004 in the hospital have been reviewed by retrospective study. Among of them, there are 9 males and 4 females. There are 4 cases of acute severe pancreatitis,3 cases of first resection and anastomosis of colonic cancer with acute obstruction ,2 cases dur to retroperitoneal hema- toma, 2 cases superior mesenteric artery embolization, 1 case of cirrhosis and splenomegaly with Hyper-splenism, 1 case of acute suppurative cholangitis. Of all 13 patients, 3 patients received non -operative therapy, 10 patients received operation therapy. Two patients used mechanical ventilation support, one patient got continues bedside blood purification therapy. Of 10 operative patients, incision relaxation suture, drainage of peritoneal and cavity were performed in 8 cases, temporary abdominal closure with polypropylene patch after drainage operation were performed in 2 cases. Results In 13 patients,6 were cured,7 were dead. Conclusion For critical surgical patients presented with ACS, the mortality rate is high. Early identification and timely surgical depressurization are essential to reduce morality and improve the prognosis.