损伤控制在Ⅲ级以上肝破裂患者救治中的应用  

Effectiveness of Damage Control Surgery in Treating Patients with Grade III or Higher Traumatic Liver Injury

作　　者：刘燕 尚培中[2] 李晓武[2] 王金[2] 马丽琼[3] 聂阿娜 张伟[2] 尚丹丹 刘冰[2] LIU Yan;SHANG Pei-zhong;LI Xiao-wu;WANG Jin;MA Li-qiong;NIE A-na;ZHANG Wei;SHANG Dan-dan;LIU Bing(Department of Critical Care Medicine,The First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China;Department of General Surgery,The 81 st Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China;Department of Critical Care Medicine,The 81 st Group Army Hospital of the PLA,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第一医院重症医学科,河北张家口075000 [2]中国人民解放军陆军第八十一集团军医院普通外科,河北张家口075000 [3]中国人民解放军陆军第八十一集团军医院重症医学科,河北张家口075000

出　　处：《河北北方学院学报（自然科学版）》2023年第10期9-12,共4页Journal of Hebei North University:Natural Science Edition

基　　金：张家口市大健康和生物医疗专项重点研发计划项目(No.2021048D);中国人民解放军陆军第八十一集团军医院2022年度院级课题(No.5)。

摘　　要：目的探讨损伤控制性手术在Ⅲ级以上肝破裂患者救治中的应用效果。方法回顾性分析采取损伤控制性手术治疗的24例Ⅲ级以上外伤性肝破裂患者临床资料,其中Ⅲ级9例,Ⅳ级13例,Ⅴ级2例。手术程序主要分为一期控制性手术治疗、复苏治疗、二期确定性手术治疗3个阶段。结果24例一期控制性手术治疗患者中因腹腔内压力较高使用无菌营养袋暂时关腹3例,严重肝脏多处碎裂伤留置体外可控式第一肝门阻断带2例;救治成功22例,因弥漫性血管内凝血、合并重度颅脑损伤死亡2例。重症医学科复苏治疗22例,4~8 d各种生命体征及血液化验指标基本恢复正常后施行二期确定性手术治疗,术后腹腔感染导致败血症死亡1例,死亡率为4.5%(1/22);其他并发症:胆漏3例,继发性肝脓肿2例,胸腔少量积液2例,B级胰漏1例,均通过充分引流、抗感染、营养支持等措施治愈。本组24例患者行控制性手术治疗总体成功率为87.5%(21/24),总体死亡率为12.5%(3/24)。结论采用损伤控制性手术治疗Ⅲ级以上肝破裂有利于维护患者血流动力学稳定性,逆转和纠正致死性三联征的恶性循环,提高救治成功率,降低死亡率。Objective To investigate the effectiveness of damage control surgery in treating patients with grade III or higher traumatic liver injury.Methods A retrospective analysis was conducted on the clinical data of 24 patients with grade III or higher traumatic liver injury who had undergone damage control surgery.Among the patients,there were 9 cases of grade III,13 cases of grade IV,and 2 cases of grade V.The surgical procedure consisted of three stages:initial control surgery,resuscitation therapy,and definitive surgery.Results Out of the 24 patients who had undergone primary control surgery,3 cases required temporary closure using an aseptic nutrition bag due to high intraperitoneal pressure,and 2 cases remained controllable first hilar blocking band due to severe multiple liver lacerations.Overally,22 cases were successfully treated,resulting in a success rate of 91.7%(22/24).Two cases resulted in mortality,primarily due to diffuse intravascular coagulation and severe craniocerebral injury.After receiving intensive care department resuscitation,22 cases were treated further.Once all vital signs and blood test indices were restored to normal within 4~8 days,definitive surgical treatment was performed.Unfortunately,one case died from septicemia caused by postoperative abdominal infection,resulting in a mortality rate of 4.5%(1/22).Other complications included biliary leakage in 3 cases,secondary liver abscesses in 2 cases,small amounts of pleural effusion in 2 cases,and grade B pancreatic leakage in 1 case.These complications were successfully resolved through appropriate drainage,anti-infection measures,and nutritional support.The overall success rate was 87.5%(21/24),and the overall mortality rate was 12.5%(3/24).Conclusion The utilization of damage control surgery in treating grade III or higher traumatic liver injury proves beneficial in maintaining patients’hemodynamic stability,reversing and correcting the vicious cycle of the fatal triad,improving the treatment success rate,and reducing mortality.

关 键 词：创伤 外伤性肝破裂 损伤控制性手术 

分 类 号：R657.3[医药卫生—外科学]