外伤性肝破裂并发腹腔室膈综合征的诊断和处理

The Diagnosis and Management of Abdominal Compartment Syndrome following Traumatin hepatorrhexis (hepatic rupture)

目的 :总结外伤性肝破裂并发腹腔室隔综合征 (ACS)的诊断和处理经验。方法 :回顾性分析 2例外伤性肝破裂 ,失血性休克并发 ACS病例 ,皆以其临床特征得出诊断。一旦确定 ACS诊断 ,立即开腹减压。用 3L 无菌静脉营养用透明塑料袋 ,剪开两边成三角帽状覆盖于膨出肠曲 ,并缝于切口皮缘 ,暂时性“关腹”。结果 :采用剑突至耻骨联合大切口开腹减压 ,结果满意。 1例术后 ACS缓解 ,但因呕吐窒息死亡 ,1例治愈出院。结论 :诊断 ACS的关键是认识 ACS的临床特征 ,ACS一旦确诊应及时开腹减压 ,唯有作正中大切口开腹才能充分减压 ,用 3L无菌塑料袋暂时性“关腹”

Objective: To evaluate our experience of the diagnosis and management for patients with abdominal compartment syndrome(ASC) following traumatin hepatorrhexis chepatic rapture. Methods: A retrospective study on 2 cases with ACS following traumatic hepatorrnexis, diagnosis were established by the unique clinical course. Emergent laparotomy and decompression of the abdominal cavity was obligatory. The swollen edematous intestinal loop emerged and herniated from the abdominal incision promptly. A sterile plastic sheet was placed covering the herniated abdominal content in 2 cases, usually a steril 3 liters tranfusion plastic bag was used with two edges being opened, and the sheet was sutured continously tightly to skin edges of the incision with nonabsorbable suture temporarily. Results: One case died from aspiration pneumonia accidentally at recovery room eventually although ACS got satisfactory. One case recovered uneventfully. Conclusions: The key to diagnose ACS is closely finding out the unique abdominal change of meteorism and concurrent oligouria, dyspnea and cardiovascular failure. Emergency laparotomy and decompression with a long median incision are mandatory as soon as possible. We prefer a 3 liters plastic sterile bag with two edges opened to cover the herniated abdominal content and sutured to the incision.