Bageacu S, Kaczmarek D, Porcheron J
Service de Chirurgie Générale et Digestive, Hôpital Bellevue, CHU de Saint Etienne, Saint Etienne.
J Chir (Paris). 2004 Jul;141(4):243-9. doi: 10.1016/s0021-7697(04)95603-7.
Traumatic retroperitoneal hematoma (RPH) may arise from injury to bony structures, major blood vessels, and intestinal or retroperitoneal viscera. To categorize the management of RPH, the retroperitoneum may be divided into three zones. Zone 1 (central) extends from the esophageal hiatus to the sacral promontory. Zone 2 (lateral) extends from the lateral diaphragm to the iliac crest. Zone 3 (pelvic) is confined to the retroperitoneal space of the pelvic bowl. For the traumatized patient with RPH, laparotomy is mandated by persistent hemodynamic instability despite intensive volume replacement. The judgment of whether and when to explore the retroperitoneal hematoma is guided by the mechanism of injury (blunt or penetrating) and the location of the RPH. RPH localized to the upper central area (Zone 1) after penetrating trauma implies injury to the great vessels and always requires urgent surgical exploration. RPH in other zones should be evaluated by CT and/or angiography; ongoing hemorrhage may respond to therapeutic embolization.
创伤性腹膜后血肿（RPH）可能源于骨结构、主要血管以及肠道或腹膜后脏器的损伤。为了对RPH的处理进行分类，腹膜后可分为三个区域。1区（中央区）从食管裂孔延伸至骶岬。2区（外侧区）从膈肌外侧延伸至髂嵴。3区（盆腔区）局限于盆腔的腹膜后间隙。对于患有RPH的创伤患者，尽管进行了大量补液，若仍存在持续的血流动力学不稳定，则需行剖腹手术。对于是否以及何时探查腹膜后血肿的判断，取决于损伤机制（钝性或穿透性）以及RPH的位置。穿透性创伤后位于上中央区域（1区）的RPH提示大血管损伤，通常需要紧急手术探查。其他区域的RPH应通过CT和/或血管造影进行评估；持续性出血可能对治疗性栓塞有反应。
