重症急性胰腺炎并发腹腔室隔综合征的诊断和治疗

THE DIAGNOSIS AND THERAPY OF ABDOMINAL COMPARTMENT SYNDROME DURING SEVERE ACUTE PANCREATITIS

目的 总结重症急性胰腺炎 (SAP)并发腹腔室隔综合征 (ACS)的诊治经验。方法 结合 SAP病史 ,复苏液体量已足够时 ,在腹膨胀、腹壁紧张后出现心肺肾功能不全即可诊断 ACS,膀胱测压作诊断辅助。诊断确立后及时开腹减压引流 ,3升静脉营养袋暂时性关腹。结果 2 1例 (2 3例次 ) ACS患者中 ,行开腹减压术 1 8例次 ,死亡 3例 (1 6 .7% ) ,未手术 5例次 ,死亡4例 (80 % ) ,总死亡率 33.3% (7/ 2 1 ) ;7例死亡中 ,4例合并急性梗阻性化脓性胆管炎 ;诊断 ACS5 h内手术者无死亡 ;正规关腹多在开腹减压术后 3～ 5 d进行 ,最迟 1例为术后 8d;6例迟发性 ACS均由腹腔腹膜后感染性坏死引起。结论 SAP患者在SIRS和感染期均可发生 ACS,并在病理基础上有其特殊性 ;及时诊断 ACS和开腹充分减压 ,3升静脉营养袋暂时性关腹是治疗

Objective To summarize the experience of diagnosis and therapy of abdominal compartment syndrome during severe acute pancreatitis.Methods According to the history of severe acute pancreatitis,after effective fluid resuscitation,patients who had kidney,pulmonary and heart function close behind abdominal expansion and abdominal wall tension should be considered suffering from ACS.Cystometry could be performed to confirm diagnosis.Emergent sufficient decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag must be performed.It is also important to prevent reperfusion syndrome.Result In 23 cases of ACS,there were 18 cases performed emergent decompressive celiotomy and 5 cases not.In the former,3 patients died(16.7%).In the later,that was 4(80%).Total mortality rate was 33.3%(7/21).In 7 death cases,there were 4 patients with acute obstructive suppurative cholangitis (AOSC).The patients performed emergent decompressive celiotomy at 5h after confirming ACS all were survived.The formal abdominal closure was performed mostly in 3 to 5 days after emergent decompressive celiotomy,individually at 8 days.6 cases of delayed ACS all attribute to infectious necrosis in abdominal cavity and retroperitoneum.Conclusion ACS can emerge in SIRS and infection period during SAP,and has different pathophysiological basis,early diagnosis, emergent decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to cure it.