胸腹联体婴儿分离术后腹腔室隔综合征的诊治体会  

Diagnosis and treatment of abdominal compartment syndrome of the thoracoventropagus after commissurotomy

作　　者：田延锋[1] 赵增仁[1] 李芳[1] 张学明[1] 张峰[1] 刘擘[1] 裴永彬[1] 吴换波[1] 戴拥军[1] 宋步需[1] 

机构地区：[1]河北医科大学第一医院普外科,河北石家庄050031

出　　处：《中国现代医学杂志》2010年第21期3347-3349,3353,共4页China Journal of Modern Medicine

摘　　要：目的探讨胸腹联体婴儿分离术后腹腔室隔综合征(ACS)的诊治及预防。方法回顾性分析河北医科大学第一医院于2007年7月22日为1例胸腹联体婴儿进行分离术的临床资料。结果联体婴儿A婴和B婴分离成功,分离后腹壁巨大缺损应用PRECLUDE心包膜加聚丙烯网片修复成功。术后A婴恢复较顺利,无腹腔并发症发生,至今仍存活。B婴于术后14 d出现肠梗阻,经保守治疗无效,产生ACS,于25 d急行剖腹探查术,术中见存在4处黏连性肠梗阻,小肠严重扩张,壁薄,透亮,即破,行相应处理后24 h内,ACS显著好转。但因术后并发严重肺部感染抢救无效,于术后53 d死亡,共存活78 d。结论胸腹联体婴儿分离术后ACS易作出诊断,及时剖腹减压是最有效的治疗方法,ACS预后不良但可以预防。【Objective】 To investigate the diagnosis and treatment of abdominal compartment syndrome（ACS） of the thoracoventropagus after commissurotomy.【Methods】 The clinical data of the surgical separation on the thoracoventropagus in The First Hospital of Hebei Medical University were retrospectively studied.【Results】 The thoracoventropagus,infants A and B,were successfully separated.After separation,huge defect of abdominal walls was successfully repaired by Preclude pericardial membrane and polypropylene mesh.After the operation,infant A recovered smoothly and is still alive without celiac complication.Intestinal obstruction was found in infant B on the 14th day after the surgery and it was inefficacious by way of conservative treatment.ACS was found on the 25th day,and emergency laparotomy exploration was done to infant B.Four sites of adhesive intestinal obstruction were found in the surgery.Serious dilatation of small bowel was found with thin wall and about to rupture.ACS improved significantly after the treatment within 24 hours.Severe pulmonary infection took place after the operation.On the 53rd day,infant B died after surviving for 78 days.【Conclusion】 The diagnosis of ACS in the thoracoventropagus after commissurotomy can be easily established.Emergency decompressive laparotomy is the most effective method for the treatment of ACS.The prognosis of ACS is poor,but ACS is preventable.

关 键 词：联体婴儿 肠黏连 肠梗阻 腹腔室隔综合征 外科手术 

分 类 号：R656[医药卫生—外科学]