腹膜后血肿的手术决策

Decision of surgical treatment for retroperitoneal hematoma

目的 探讨腹膜后间隙不同区域血肿的来源和手术决策。方法 回顾性分析 13 2例腹膜后血肿患者的临床资料。结果 腹膜后I区血肿 2 8例 ,其中十二指肠损伤 10例 ( 3 5 .71% ) ,胰腺损伤 10例 ( 3 5 .71% ) ,胰、十二指肠同时损伤 5例 ( 17.86% ) ,大血管损伤 2例 ( 7.14 % ) ,胸腰椎骨折 1例 ( 3 .5 7% )。II区血肿 45例 ,其中肾损伤 3 8例 ( 84.44 % ) ,结肠损伤 7例 ( 15 .5 6% )。III区血肿 5 9例 ,其中骨盆骨折 44例 ( 74.5 8% ) ,膀胱损伤 6例 ( 10 .17% ) ,直肠损伤 5例 ( 8.47% ) ,直肠膀胱同时损伤 4例 ( 6.78% )。腹膜后血肿必经切开血肿者 ,I( 94.43 % ) ,II( 91.11% )区比较差异无显著性 ( χ2 =0 .89,P >0 .0 5 ) ,I ,III区 ( 2 8.81% )比较差异有高度显著性 ( χ2 =3 4.73 ,P <0 .0 1) ;II ,III区比较差异有高度显著性 ( χ2 =40 .75 ,P <0 .0 1)。结论 腹膜后I区血肿应积极切开探查 ,并处理受损器官 ;II区血肿原则上应切开处理 ;III区血肿 ,在排除直肠膀胱等器官损伤后 ,可不必行血肿切开探查。

Objective To study the sources and the dicision of surgical treatment for retroperitoneal hematoma(RPH). Methods The clinical data of 132 patients with RPH were analyzed retrospectively. Results Retroperitoneal area (RPA) can divided into I,II,III areas.The injuries occurred in the RPA I area in 28 patients, including 10 with duodenum injury (35.71%), 10 with pancreas injury (35.71%), 5 with both duodenum and panereas injury (17.86%), 2 with large blood vessel injury(7.14%) and 1 with fracture of spinal column(3.57%).Injuries occurred in the RPA II area in 45 patients, including 38 patients with kidney injury (84.44%),7 with colon injury (15.56%).Injuries occurred in the RPA III area in 59 patients, including 44 patients with pelvic fracture (74.58%), 6 with bladder injury ( 10.7%), 5 with rectal injury(8.47%)and 4 with both bladder and rectal injury (6.78%).The injuries had to be treated surgically in I area (94.43%) and II asea(91.11%) was no significant difference (χ2=0.89 P>0.05),but between the I,II area and III area(28.81%) were significant difference (χ2=34.73 P <0.01; χ2=40.75, P< 0.01,respetively).Conclusions The hematoma in the RPA I area should be opened and treated actively. It should be opened and treated principlely if the hematoma is appeared in the RPA II area. It should avoid to open the hematoma in the RPA III area,if the injury of bladder or rectum can be excluded.