损伤控制性手术在以肝破裂为主的腹部多发性损伤中的临床应用  

Damage control surgery is given priority to abdominal multiple injury with hepatic rupture in clinical application

作　　者：陈飞[1] 邬善敏[1] 张贯启[1] 范迪欢 

机构地区：[1]武汉大学人民医院肝胆腔镜外科,武汉430060

出　　处：《临床急诊杂志》2017年第4期273-276,共4页Journal of Clinical Emergency

摘　　要：目的:探讨损伤控制性手术(DCS)在以肝破裂为主的腹部闭合性多发伤抢救中的应用价值。方法:回顾性分析2012-01-2015-12收治的25例外伤致腹部闭合性多发伤患者的临床资料,按手术思路分为一期确定手术组(对照组,n=12)和DCS组(n=13)。比较2组病死率、并发症发生率、损伤严重程度评分(ISS)、凝血功能、乳酸清除时间、住院时间等指标。结果:对照组抢救成功7例(58.3%),死亡5例(41.7%)。主要死亡原因是休克不能改善及其并发症导致死亡。并发症9例(75.0%),其中急性呼吸窘迫综合征(ARDS)3例,切口感染1例,多器官功能障碍综合征(MODS)1例,出血2例,弥散性血管内凝血(DIC)1例,胆瘘1例。DCS组抢救成功11例(84.6%),死亡2例(15.4%),死亡原因为ARDS和MODS。并发症3例(23.1%),其中ARDS 1例、MODS1例、出血1例。DCS组围手术期病死率、并发症发生率、血清乳酸清除时间、体温恢复时间、PT及APTT恢复时间、凝血酶原时间均显著低于对照组(P<0.05)。结论:DCS在严重腹部创伤抢救时疗效确切。Objective：To explore the value of the damage control surgery（DCS） in the application of the closed abdominal multiple trauma. Method：A retrospective analysis in January 2012 to December 2015 was performed on 25 cases of closed abdominal multiple injury. According to the operation ideas the patients were divided into control group （12 cases）and DCS group （13 cases）. And the mortality, incidence of complications,injury severity score （ISS）, blood coagulation function, lactic acid removal time, and length of hospital stay indicators were compared be- tween two groups. Result： seven cases were rescued successfully （58.3 % ） and 5 cases died （41.7 % ） in the control group. The main reason was shock and its complications. The complications included （9 cases）incision infection （1 case） ,respiratory distress （3 cases）, multiple organ failure （1 case）, diffuse intravascular coagulation （1 Case）, hemorrhage （2 cases）and bile leakage （1 case）. Eleven patients inDCS groupwere rescued successfully（84.6 % ）and two patients died（15.4%）. The cause of death was respiratory distress and multiple organ failure. The complica- tionsincluded respiratory distress（l case） ,multiple organ failure（1 case）and bleeding （1 case）. Compared with con- trol group,DCS group perioperative mortality and complication rates, serum lactic acid removal time, temperature recovery time,activated partial thrombin time, prothrombin time were significantly lower （P〈0.05）. Conclusion： DCS in severe abdominal trauma has good curative effect.

关 键 词：损伤控制性手术 肝破裂 腹部多发伤 临床应用 

分 类 号：R641[医药卫生—外科学]