暴发性急性胰腺炎并发腹腔室隔综合征临床诊治进一步探讨

A clinical study on abdominal compartment syndrome （ACS） secondary to fulminant acute pancreatitis （FAP）

目的探讨暴发性急性胰腺炎并发腹腔室隔综合征的治疗方案。方法回顾性分析1998年1月至2007年3月共收治FAP并发腹腔室隔综合征31例的诊治经验，对收治的31例暴发性急性胰腺炎并发腹腔室隔综合征患者根据腹腔内压力、腹腔室隔综合征分型，以及早期（发病后3d内）手术治疗与非手术治疗结果进行总结。结果31例暴发性急性胰腺炎并发腹腔室隔综合征患者13例行非手术治疗，其中轻度腹腔室隔综合征者5例（死亡1例），中、重度8例（死亡4例）；3d内早期手术治疗18例，其中轻度腹腔室隔综合征者5例（死亡2例），中、重度13例（死亡4例）。当腹腔内压力〉21mmHg时，早期手术治疗组死亡人数明显低于早期非手术治疗组（P〈0．05）。根据ACS分型，Ⅰ型非手术治疗5例（死亡2例），Ⅱ型非手术治疗4例（死亡2例），Ⅲ型非手术治疗4例（死亡2例）；Ⅰ型手术治疗9例（死亡2例），Ⅱ型4例（死亡2例），Ⅲ型5例（死亡2例）。Ⅰ型手术治疗组死亡人数明显低于非手术治疗组（P〈0．05），Ⅱ、Ⅲ型两组手术治疗组与非手术治疗组比较，死亡人数差异无统计学意义（P〉0．05）。结论当腹腔内压力〉21mmHg，且CT提示为Ⅰ型ACS的FAP患者，宜尽早行有效的腹腔减压引流；而对于腹腔内压力〉21mmHg，CT提示为Ⅱ、Ⅲ型ACS的FAP患者，早期手术减压效果有待进一步观察。

Objective To evaluate the treatment choice of abdominal compartment syndrome （ACS） secondary to fulminant acute pancreatitis （FAP）. Methods We retrospectively analyzed therapeutic results of 31 ACS cases secondary to FAP from Jan 1998 to March 2007. Results Five cases with mildly elevated pressure of abdominal cavity received conservative therapy with one death. Eight cases with moderate or severe increase of the pressure of the abdominal cavity received conservative therapy with 4 deaths. Whereas among the 5 cases with mildly elevated pressure undergoing operative therapy two died, in contrast to the 13 cases with moderately and severely elevated pressure who received operative therapy with four deaths. According to ACS classification, there were 5 cases of type Ⅰ ,4 cases of type Ⅱ and 4 cases of type Ⅲ, which received conservative therapy, with respective 2,2, and 2 deaths. Whereas 9 cases in type Ⅰ ,4 cases in type Ⅱ and 5 cases in type Ⅲ underwent respectively operative therapy resulting in respective 2 deaths in each groups. Conclusion In cases of ACS, when the intraabdominal cavity pressure is higher than 21 mm Hg, and CT indicates type Ⅰ of ACS, laparotomy should be recommended at the early phase of disease.