急性重症胰腺炎合并腹腔间室综合征临床分析

目的探讨急性重症胰腺炎（SAP）合并腹腔间室综合征（ACS）的诊断及治疗.方法回顾性分析160例SAP合并腹腔高压（IAH）患者的临床资料,从发病原因、腹压增高程度、治疗、预后等方面量化指标结合病理生理特点进行探讨、总结.结果160例SAP合并IAH患者中诊断为ACS17例（17/160,14.16%）.高脂血症性急性胰腺炎13例（13/17,76.5%）.原发型ACS 12例（12/17,70.6%）、迟发型ACS 5例（5/17,29.4%）.迟发型ACS全部行开腹减压手术,无死亡病例;原发型ACS开腹减压手术治疗6例（6/12,50.0%）,死亡5例（5/6,83.3%）,保守治疗6例（6/12,50.0%）,死亡2例（2/6,33.3%）.结论重症胰腺炎合并腹腔间室综合征病情严重,微创腹腔穿刺减压疗效显著,原发性ACS选择开腹减压手术应谨慎,迟发型ACS开腹减压手术效果良好.

Objective To investigate the the diagnosis and treatment for severe acute pancreatitis（SAP）complicated with abdominal compartment syndrome（ACS）. Methods A retrospective analysis of 160 cases of SAP complicated with intra-abdominal hypertension（IAH）in patients with clinical data,from the cause of disease,abdominal pressure, treatment,prognosis and quantitative index set to its pathophysiological characteristics was performed. Results In 160 cases of SAP complicated with IAH in 17 cases（17/160,10.6%）ACS diagnosis：acute hyperlipidemic pancreatitis in 13 cases （13/17,76.5%）,12 cases of primary ACS（12/17,70.6%）,5 cases of late-onset ACS（5/17,29.4%）,decompressive laparotomy operation was performed in all delayed ACS with no mortalities;primary ACS decompressive laparotomy operation was performed in cases（6/12,50%）with 5 cases of death（5/6,83.3%）,conservative treatment was performed in 6 cases（6/12,50%）with 2 cases of death（2/6,33.3%）. Conclusion Severe pancreatitis complicated with abdominal compartment syndrome severity,the effect of minimally invasive abdominal puncture decompression is significant,selected decompressive laparotomy operation should be cautious for performing in the primary ACS,delayed ACS decompressive laparotomy operation has a good therapeutic effect .