损伤控制性手术在严重肝脏外伤中应用.docVIP

损伤控制性手术在严重肝脏外伤中应用【摘要】 目的 探讨损伤控制性手术(DCS)应用于严重肝脏外伤的临床价值,总结治疗经验。方法 回顾性分析2005年1月至2009年9月,采用DCS原则治疗18例严重肝脏外伤的手术资料。结果 18例患者均经损伤控制性手术治疗 SICU复苏后,所有患者都接受再次确定性手术。治愈17例(94.4%),近期并发症发生率为27.8%(再出血1例,再次手术止血。膈下感染+胆漏1例,应激性溃疡1例,胆漏2例)。死亡1例(5.6%),死亡原因与手术无关。结论 符合DCS指征的严重肝脏外伤的患者,应积极选择适宜的手术治疗方式,并应根据损伤的不同部位和程度,分次手术治疗。 【关键词】 肝脏创伤;损伤控制性手术 The application of Damage control surgery for severe hepatic trauma CHEN Xiong. Department of Hepatobiliary Vascular Surgery,The 3rd Hospital of Xiamen City,Fujian 361100,China 【Abstract】 Objective To explore the value of damage control surgery(DCS) and To study the experience of the treatment for severe hepatic trauma.Methods A retrospective analysis was done on preference of 18 patients with severe hepatic trauma under DCS treatment from Jan,2005 to Sep,2009.Results DCS were performed in all 18 patients,and all patients were performed reoperations after damage control resuscitation therapy in surgical intensive care unit(SICU).The cure rate was 94.4%with 17 cases.The rate of complication incidence was 27.8%(re-bleeding:5.6%with 1 case after reoperations,subphrenic abscess and biliary fistula:5.6%with 1 case,stress ulcer:5.6%with 1 case,biliary fistula:11.1%with 2 cases),and all healed by conservative treatments.The mortality rate was 5.6%with 1 case.and it didn’t relate to DCS.Conclusion Consideration for DCS should be made positively under DCS indication to severe hepatic trauma patients.According to the difference of location and degree of hepatic injury,choosing eligible reoperations modus is the key management. 【Key words】Severe hepatic trauma;Damage control surgery 肝脏是腹部最易受损的脏器之一,仅次于脾和胃肠道损伤占第3位,总病死率为10%~20%,严重肝损伤的病死率高达50%以上,合并肝静脉或肝后下腔静脉损伤的病死率可达80%~90%。严重肝外伤是腹部创伤中救治难度最大的创伤之一。我院2005年1月至2009年9月共收治肝外伤109例,其中18例为严重肝外伤,通过损伤控制性手术,取得较好的治疗效果。 1 资料和方法 1.1 一般资料 本组男13例,女5例,年龄17~51岁,平均33.4岁;闭合性损伤17例,其中交通事故15例,坠落伤1例,挤压伤1例;开放性损伤1例为刀刺伤。15例合并其他脏器损伤,其中肝外伤+肋骨骨折+血气胸7例;肝外伤+肋骨骨折+血气胸+颅脑损伤2例;肝外伤+肋骨骨折+气胸+脾破裂2例;肝外伤+胰腺损伤1例;肝外伤+小肠破裂3例。损伤位于肝右叶伤14例;肝左叶伤2例