开腹减压治疗重症急性胰腺炎并发腹腔间室综合征

Decompressive laparotomy in the treatment of severe acute pancreatitis complicated with abdominal compartment syndrome

腹腔间室综合征（abdominal compartment syndrome, ACS） 是重症急性胰腺炎 severe acute pancreatitis,SAP）的危重并发症之一。25年来，开腹减压在SAP并发ACS的治疗中得到了越来越广泛的应用。但开腹减压在挽救了大量ACS患者生命的同时，也带来了许多棘手的并发症。故在SAP并发ACS时，应充分权衡开腹减压的利弊，提高治疗效果。

Abdominal compartment syndrome （ ACS ） is an important factor contributing to the multiple organ dysfunction syndrome which is commonly seen in patients with severe acute pancreatitis （SAP）. As a life-saving procedure, decompressive laparotomy is widely applied to patients with SAP complicated with ACS, especially to patients with edema of the visceral tissues caused by massive fluid resuscitation at the early stage of the disease. However, decompressive laparotomy should be adopted with caution since it is associated with enteroatmospheric fistula, intraabdominal infection, postoperative ileus, third space losses, hypothermia and hernia. Therefore, decompressive laparotomy should only be considered after conservative management had failed. The indications for decompressive laparotomy are as follows： （1） intraabdominal pressure 〉 25 mm Hg; （2） adequate ventilation of the patient is difficult; （3） percutaneous drainage of ascites is not helpful. Timely temporal abdominal closure is helpful in preventing complications. Infected peripancreatic necrosis is the indication for peripancreatic exploration or necrosectomy. A thorough know-ledge of decompressive laparotomy is essential for individualized management of patients with SAP complicated with ACS.