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目的 探讨乙状结肠癌合并不完全性肠梗阻腹腔镜根治术后，因腹直肌出血导致患者不明原因发热及降钙素原（PCT）异常升高的临床表现、诊断过程及治疗策略。方法 回顾性分析中国医学科学院肿瘤医院2024年12月收治的1例乙状结肠癌合并不完全性肠梗阻患者的临床资料、手术情况、术后发热的诊疗过程。结果 患者男，61岁，因乙状结肠癌合并不完全性肠梗阻行腹腔镜乙状结肠癌根治术及预防性回肠造口术，患者术后使用头孢曲松钠（1.0 g，每天2次，静脉滴注）常规抗感染第2天出现发热伴PCT异常升高（>50 ng/mL），行血培养、引流液培养；查体见患者右侧腰背部出现红色包块，压痛阳性，超声提示术区皮下多发血肿，CT明确诊断为腹直肌血肿；遂予注射用亚胺培南西司他丁钠（泰能）抗感染，同时外敷莫匹罗星软膏。经调整方案治疗后，患者体温恢复正常，PCT水平明显下降，血培养、引流液培养结果为阴性。随访1个月时皮肤红肿完全消退，恢复良好。结论 腹直肌出血可引起局部皮下血肿和组织炎症，导致术后非感染性发热及PCT异常升高；临床工作中应警惕此类少见术后发热原因，结合查体及影像学检查结果，及时进行针对性治疗，尽快控制炎症反应，以改善患者预后。
Abstract：Objective To investigate the clinical manifestations, diagnostic process, and treatment strategies for unexplained postoperative fever and abnormally elevated procalcitonin(PCT) levels caused by rectus abdominis hemorrhage following laparoscopic radical surgery for sigmoid colon cancer complicated with incomplete intestinal obstruction. Methods A retrospective analysis was conducted on the clinical data, surgical procedure, and diagnosis and treatment of postoperative fever in a patient admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences in December 2024. The patient presented with sigmoid colon cancer complicated by incomplete intestinal obstruction. Results A 61-year-old male patient underwent laparoscopic radical resection for sigmoid colon cancer and prophylactic ileostomy due to incomplete intestinal obstruction. Twenty-four hours after surgery, while receiving routine prophylactic antibiotics(ceftriaxone sodium, 1. 0 g twice daily, IV infusion), the patient developed fever accompanied by markedly elevated PCT(> 50 ng/mL). Blood cultures and drainage fluid cultures were obtained. Physical examination revealed a tender, red mass over the right lumbar region. Ultrasonography indicated multiple subcutaneous hematomas in the surgical area, confirmed by CT as a rectus abdominis hematoma. Treatment was adjusted to intravenous imipenem-cilastatin sodium and topical mupirocin ointment. Following this intervention, the patient's temperature normalized, PCT levels significantly decreased, and both blood and drainage fluid cultures returned negative. At the one-month follow-up, the skin erythema and swelling had completely resolved, and the patient recovered well. Conclusions Rectus abdominis hemorrhage can induce localized subcutaneous hematoma and tissue inflammation, resulting in postoperative non-infectious fever and abnormal PCT elevation. Clinicians should remain vigilant for this uncommon cause of postoperative fever. Timely diagnosis, aided by physical examination and imaging, and targeted treatment are crucial to rapidly control the inflammatory response and improve patient prognosis.
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基本信息:
DOI：
中图分类号:R735.35
引用信息:
[1]任培德,赵志勋,程璞,等.乙状结肠癌合并不完全性肠梗阻腹腔镜根治术后腹直肌出血致发热及降钙素原异常升高1例[J].山东医药,2025,65(10):14-18.
基金信息:
国家自然科学基金项目（82473407）; 北京市朝阳区科技计划项目（CYSF2223）