腹腔室隔综合征的早期手术处理

目的 总结腹腔室隔综合征（abdominal compartment syndrome，ACS）的诊断和早期手术治疗经验。方法 13例ASC患者原发病为：重症急性胰隙炎（severe acute panereatitis，SAP）6例，腹部剜合性损伤内出血3例，腹部率中、肠扭转、急性胃穿孔伴腹腔严重感染及结肠癌晚期肠梗阻各1例，均以膀胱压力（urinary bladder pressure，UBP）俭测和临床特征得以确诊。其中UBP轻度升高3例，中度升高6例，重度升高4例。13例行早期剖腹、腹腔减压术、胃肠腔内减压引流术和其他综合处理措施。结果 确诊后12h内手术者7例，1例结肠癌患者术后伤口全层裂开，腹腔感染、感染性休克而残废；12～24h内手术者3例，1例SAP患者伴发席汉氏综合征术后死于成人呼吸窘迫综合征；超过24h手术者3例，2例SAP患行死于多器官功能障碍UBP中、高度升高者各死亡2例。病死率为30．8％（4／13）、结论 ACS一旦确诊，尤其是中、重度患者应早期开腹，充分减压引流，才可望改善预后。

Early Surgical Intervention for Abdominal Compartment Syndrome

Objective To summarize the experience of diagnosis and early surgical intervention for abdominal compartment syndrome(ACS). Method 13 cases of ACS secondary to severe acute pancreatitis(SAP) in 6 cases, close abdominal trauma and intra-abdominal hemorrhage in 3 cases, abdominal apoplexy in 1 case, volvulus in 1 case, acute gastric perforation and severe abdominal infection in 1 case, advanced colon carcinoma and intestinal obstruction in 1 case. Diagnosis of ACS was established by measurement of urinary bladder pressure (UBP) and evaluation of clinical features. UBP increased mildly in 3 cases, moderately in 6 cases, significantly in 4 cases. All the cases underwent early laparotomy, intra-abdominal decompression, gastrointestinal decompression and drainage, and comprehensive treatment. Result After diagnosis established, 7 cases underwent surgery within 12 hours of which 1 case of colon carcinoma died of septic shock, 3 cases underwent surgery within 12 to 24 hours of which 1 case of SAP died of acute respiratory distress syndrome, 3 cases underwent surgery over 24 hours of which 2 cases of SAP died of multiple organ dysfunction syndrome. There were 2 death occurred each in the cases of moderate and significant increased UBP. Overall death rate was 30.8%(4/13). Conclusion An improved prognosis can be expected with early laparotomy and sufficient decompression and drainage when ACS diagnosis established, particularly in the moderate and significant cases.