腹膜后脓肿的诊断和治疗

目的探讨腹膜后脓肿的病因,诊断和治疗。方法回顾性分析了1990-2004年诊断和治疗腹膜后脓肿33例的临床资料。结果急性坏死性胰腺炎后20例,胆囊切除胆总管探查术后4例,十二指肠损伤2例,阑尾穿孔3例,肾结石4例。超声检查确诊80%(20/25),CT检查确诊100%(22/22)。经腹部腹膜后脓肿切开置管引流25例,手术1~4次不等,后腰部切开引流8例。手术后并发应激性胃粘膜损伤致消化道出血7例,成人呼吸窘迫综合征(ARDS)5例,急性肾功能衰竭3例,死亡4例。治愈时间1~6个月,平均3.5个月。结论及时明确诊断,进行有效引流并加强营养支持是治疗成功的关键。

Diagnosis and treatment of retroperitoneal abscess

Objective To investigate the causes, diagnosis and treatment of retroperitoneal abscesses. Methods The clinical data of 33 patients with retroperitoneal abscesses from 1990 to 2004 were analyzed retrospectively. Results In 33 cases of retroperitoneal abscess, 20 cases occurred after severe acute pancreatitis, 4 after undergoing cholecystectomy and choledocholithotomy, 4 with renal lithiasis, 3 with appendicitis, and 2 with duodenal trauma. The correct diagnostis rate was 80% by BUS and 100% by CT. A transabdominal laparotomy for tube placement and drainage varied from one to four times in 25 cases. Retroperitoneal laparostomy was performed in 8 cases. After operation, 7 patients were complicated with digestive hemorrhage resulting from stress gastric ulcer, 5 cases with adult respiratory distress syndrome (ARDS), 3 cases with acute renal failure, and 4 died. The average period of hospital stay was (3.5) months. Conclusions Early diagnosis, effective sugical drainage and nutritional support are the key for successful treatment.