腹膜后脓肿23例诊治体会

Experience of the diagnosis and treatment of 23 patients with retroperitoneal abscess.

目的 总结 2 3例腹膜后脓肿诊断和治疗的经验 ,认识其易致多器官功能障碍综合征 (MODS)的重要性。方法 对 1993～ 1999年诊治的 2 3例腹膜后脓肿的临床资料进行回顾性总结。结果 经腹部腹膜后脓肿引流 2 0例 ,手术 1～ 6次不等 ,B超引导下经后腰部穿刺置管引流 3例。术后合并应激性胃粘膜损害发生消化道出血 6例 ,成人呼吸窘迫综合征 (ARDS) 5例 ,急性肾衰 2例 ,腹腔内出血 1例 ,小肠瘘 3例 ,空肠结肠瘘 1例 ,霉菌感染 3例。全组平均住院 72天。死亡 4例 ,其中因ARDS、ARDS并应激性胃粘膜损害大出血、ARDS并腹腔内血管破裂出血分别死亡 1例 ,应激性胃粘膜大出血并空肠结肠瘘死亡 1例。结论 作为术后并发症 ,腹膜后脓肿常易致MODS ;对其及时诊断、充分有效的引流是预防MODS的关键。

Objective To summarize the experience of the diagnosis and treatment of 23 patients with retroperitoneal abscess,to recognize the importance that retroperitoneal abscess frequently induces multiple organ dysfunction syndrome(MODS).Methods A retrospective analysis was made of the clinical data of the diagnosis and surgical treatment of 23 cases with retroperitoneal abscess collected from 1993 to 1999.Results A transabdominal laparotomy for debridement,multiple drainages was performed with 1 to 6 times in 20 cases.The percutaneous B-US-guided retroperitoneal puncture and drainage was used in 3 patients.In these patients,6 cases were complicated with digestive hemorrhage resulted from stress gastric ulcer,5 cases with adult respiratory distress syndrome(ARDS),2 with acute renal failure,1 with intraperitoneal hemorrhage,3 cases with intestinal fistula,1 case with jejunocolonic fistula,3 cases with mycotic infection.The average period of the overall hospital stay was 72 days,4 of these 23 patients died of ARDS,ARDS with stress hemorrhagic gastric ulcer,ARDS with intractable intraperitoneal hemorrhage stress hemorrhagic gastric ulcer with jejunocolonic fistula,resperctively.Conclusion As a postoperative complication,retroperitoneal abscess easily induced MODS.Early diagnosis and effective drainage would be most important procedures for the prevention of MODS in the patients with retroperitoneal abscess.