两种手术方法对严重外伤性肝破裂患者生存率的影响  

Survival of patients with severe traumatic hepatic rupture after damage control surgery

作　　者：唐浩 宋文渊 曾凯 Tang Hao;Song Wenyuan;Zeng Kai(Department of Hepatobiliary Surgery,928 th Hospital of PLA,Haikou 571159,Hainan Province,China)

机构地区：[1]解放军第928医院肝胆外科,海口市5711595 [2]海南医学院第二附属医院肝胆外科

出　　处：《实用肝脏病杂志》2020年第2期280-283,共4页Journal of Practical Hepatology

基　　金：海南省科技厅重点科研发展计划项目(编号:ZDYF2017125)

摘　　要：目的分析比较两种不同手术方法对严重外伤性肝破裂患者生存率的影响。方法2017年4月~2019年1月在我院肝脏外科就诊的66例严重外伤性肝破裂患者,其中32例接受常规手术,34例接受损伤控制性手术(DCS)。比较近期生存率。结果DCS手术组手术时间为(141.0±10.7)min,显著短于常规手术组[(185.2±15.8)min,P<0.05],DCS手术组术中出血量为(754.6±52.3)mL,显著少于常规手术组[(1185.7±104.6)mL,P<0.05],DCS手术组创伤严重度评分(ISS)为(39.9±4.4)分,显著小于常规手术组[(46.8±5.0)分,P<0.05],休克纠正时间为(6.2±1.1)h,显著短于常规手术组[(9.1±3.4)h,P<0.05];术后检测指标比较,无显著性差异[pH值为(7.4±1.3)对(7.4±0.8),凝血酶原时间为(12.9±2.3)s对(13.0±2.8)s,部分活化的凝血酶时间为(37.1±3.2)s对(40.3±7.5)s,P>0.05];DCS组术后膈下脓肿、胆瘘、腹腔感染和应激性溃疡并发症发生率为20.6%,显著低于常规手术组的62.5%(P<0.05);DCS组生存率为88.2%,显著高于常规手术组的71.9%(P<0.05)。结论与常规手术比,施行DCS手术可显著改善严重创伤性肝破裂患者围手术期指标,有效控制术后并发症的发生,提高患者生存率。Objective The aim of this study was to investigate the survival of patients with severe traumatic hepatic rupture(STHR)after damage control surgery(DCS).Methods The clinical data of 66 patients with STHR were retrospectively analyzed in our hospital between April 17 and January 2019,and 32 patients received conventional surgery and 34 received DCS.The survival rates in short-term follow-up were compared between the two groups.Results The surgery time in the DCS group was(141.0±10.7)min,significantly shorter than that[(185.2±15.8)min,P<0.05]in the conventional surgery group,the intraoperative blood loss in the DCS group was(754.6±52.3)mL,significantly less than[(1185.7±104.6)mL,P<0.05]in the conventional surgery group,the injury severity score(ISS)in the DCS group was(39.9±4.4),significantly lower than[(46.8±5.0),P<0.05]in the conventional surgery group,and the shock correction time in the DCS group was(6.2±1.1)h,significantly shorter than[(9.1±3.4)h,P<0.05]in the conventional surgery group;the parameters monitored after operation,such aspH[(7.4±1.3)vs.(7.4±0.8)],prothrombin time[(12.9±2.3)s vs.(13.0±2.8)s]and APTT[(37.1±3.2)s vs.(40.3±7.5)s]were not significantly different(P>0.05)in the two groups;the incidences of post-operational complications,such as subdiaphragmatic abscess,biliary fistula,abdominal infection and stress peptic ulcer in DCS group was 20.6%,significantly lower than 62.5%(P<0.05)in the conventional operation group;the survival rate inDCS group was 88.2%,significantly higher than 71.9%in the conventional surgery group(P<0.05).Conclusion The application of DCS might significantly improve the perioperative indexes of patients with severe traumatic liver rupture,which is related to the less postoperative complications.

关 键 词：外伤性肝破裂 损伤控制性手术 并发症 生存率 

分 类 号：R657.32[医药卫生—外科学]