上腹部手术并发胸腔积液17例报道.doc

上腹部手术并发胸腔积液17例报道[摘要] 目的 探讨上腹部手术后并发胸腔积液的发病机制、诊断、治疗及预防措施。方法 对我院2006年4月~ 2009年7月收治的17例上腹部手术后并发胸腔积液的临床资料进行回顾性分析。结果 17例患者中脾切除术5例(29%),脾切除+断流术3例(17%),肝切除术3例(17%),胃癌根治术3例(17%),开腹胆囊切除术1例(6%),肝破裂修补术2例(14%)。所有患者采取对症治疗后均痊愈出院。结论 有效的围手术期预防可降低此病的发生率,及时、准确的诊断与治疗是此病预后的关键。 [关键词] 上腹部手术; 胸腔积液 [中图分类号] R656;R561.3 [文献标识码] A [文章编号] 1673-9701(2010)15-120-02 Pleural Effusion Due to Upper Abdominal Surgery:A Report of 17 Cases WANG Dawei Daqing City Longfeng District Peoples Hospital,Daqing 163711,China [Abstract] ObjectiveTo explore the pathogenesis,diagnosis,treatment and prophylaxis of pleural effusion due to upper abdominal surgery. MethodsSeventeen cases of pleural effusion due to upper abdominal surgery treated in our hospital from April 2006 to July 2009 were analyzed retrospectively. ResultsIn 17 cases,5 cases(29%) received splenectomy,3 cases(17%) received splenectomy with disconnection,3 cases(17%) received hepatectomy,3 cases(17%) received radical gastrectomy for cancer,1 case(6%) received exploratory cholecystectomy and 2 case(14%) received hepatorrhexis repair. All cases received effective treatment and recovered. ConclusionEffective perioperative prevention can reduce the incidence of the disease. Timely,accurate diagnosis and treatment are keys to its disease prognosis. [Key words]Upper abdominal surgery; Pleural effusion 胸腔积液为上腹部手术后常见并发症,由于上腹部手术后胸腔积液的临床表现常为原发疾病所掩盖,使其不能得到及时、有效的处理,从而加重原发疾病的病情,严重影响患者的术后恢复。我院2006年4月~2009年7月收治上腹部手术后胸腔积液患者17例,现将临床资料报道如下。 1 临床资料 1.1 一般资料 本组17例患者,男9例,女8例。年龄19~67岁。门静脉高压症行脾切除术+贲门周围血管离断术3例,外伤性脾破裂行脾切除术5例,原发性肝癌行肝切除术3例,胃癌行胃癌根治术3例,胆囊结石行开腹胆囊切除术1例,外伤性肝破裂行肝修补术2例。 1.2 临床表现及诊断 本组17例患者于术后7~12d均出现不同程度的胸闷和呼吸急促等呼吸系统症状,并伴随低热现象(37.2℃~38.3℃)。床旁胸片和彩超检查后均确诊。单发性右侧胸腔积液8例,单发性左侧胸腔积液3例,双侧胸腔积液6例。 2 结果 7例患者在积极治疗原发疾病、加强支持治疗和抗感染治疗6~11d后,胸腔积液自行吸收,痊愈出院。10例患者在支持治疗和抗感染治疗的同时,采取胸腔闭式引流治疗16~29d后,痊愈出院。 3 讨论 3.1 上腹部手术后胸腔积液的发病机制 上腹部手术后胸腔积液的发病机制复杂多样,可归纳为:①术后膈下局部压力及全腹内压升高;②肝切除术后患者肝功能不全、低蛋白血症及腹水形成也可诱发胸腔积液;③外伤性肝脾破裂患者常伴胸膜水肿,小淋巴管撕裂,渗出增加、吸收减少,