Milanchi Siamak, Magner David
Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Int J Surg. 2008 Dec;6(6):e31-3. doi: 10.1016/j.ijsu.2006.10.004. Epub 2006 Nov 1.
Compartment syndrome of the leg secondary to spontaneous bleeding has been described in coagulopathic patients. Correction of the coagulopathy and emergency fasciotomy is the recommended treatment. We present a cirrhotic patient with a short life expectancy who developed compartment syndrome of the leg secondary to spontaneous bleeding. This patient underwent fasciotomy of the leg and subsequently developed persistent postoperative bleeding and required repeated transfusions of blood and blood products. The patient eventually expired in the hospital 1 month after surgery.
Compartment syndrome of the leg occurring in patients with coagulopathy secondary to cirrhosis is very difficult to manage. Coagulopathy in these patients is hard to correct and constant bleeding from fasciotomy site is a major complication mandating frequent transfusions of blood and blood products. The complications of fasciotomy in these patients may outweigh the complications of untreated fasciotomy, particularly in patients with a short life expectancy.
Fasciotomy is not always the best treatment for compartment syndrome of the leg. In certain patients, particularly in the coagulopathic, end-stage cirrhotic patient with a short life expectancy who is not a candidate for liver transplantation, fasciotomy is not indicated. Fasciotomy should be used selectively, if at all, in patient population with end-stage and terminal diseases.
凝血功能障碍患者出现自发性出血继发小腿骨筋膜室综合征的情况已有报道。推荐的治疗方法是纠正凝血功能障碍并进行急诊筋膜切开术。我们报告了一例预期寿命较短的肝硬化患者，其因自发性出血继发小腿骨筋膜室综合征。该患者接受了小腿筋膜切开术，随后出现持续性术后出血，需要反复输注血液及血液制品。患者最终在术后1个月死于医院。
肝硬化继发凝血功能障碍患者发生小腿骨筋膜室综合征很难处理。这些患者的凝血功能障碍难以纠正，筋膜切开部位持续出血是一个主要并发症，需要频繁输注血液及血液制品。这些患者筋膜切开术的并发症可能超过未治疗的筋膜室综合征的并发症，特别是对于预期寿命较短的患者。
筋膜切开术并不总是小腿骨筋膜室综合征的最佳治疗方法。在某些患者中，特别是凝血功能障碍、预期寿命较短且不适合肝移植的终末期肝硬化患者，不建议进行筋膜切开术。对于终末期和晚期疾病患者，应谨慎选择是否使用筋膜切开术。
