损伤控制术在多发伤合并胰十二指肠损伤中的应用

Damage control surgery in severe multiple injuries combined pancreaticoduodenal injury

目的:探讨损伤控制手术在严重多发伤合并胰十二指肠损伤中的应用效果。方法:在对4例严重多发伤合并胰十二指肠损伤患者实施手术过程中,先用损伤控制术对患者进行止血,同时制止肠内容物的外溢,切除消化道未重建的胰十二指肠,临时关腹,作胰管及胆管外引流,之后再将患者转移到外科ICU待血液动力学稳定,对患者进行48h监护之后再进行二次彻底性手术,对患者的病历资料进行回顾。结果:4例患者的损伤严重程度ISS评分已经超过了16,患者的生理状态已经处于人体的极限,经治疗护理最后所有患者均痊愈出院。结论:对于严重多发伤合并胰十二指肠损伤患者,以损伤控制术并对消化道进行分阶段重建,能够有效治疗处于生命极限的患者,在临床应用上有着深远意义。

Objective: damage control surgery in severe multiple injuries combined pancreaticoduodenal injury. Method: In 4 patients with severe multiple injuries combined with pancreatic duodenal injury for patients in the surgical procedure, patients first with damage control surgery to stop bleeding, to stop the spillover of the intestinal contents, resection of pancreatic digestive tract is not rebuilding twelve secondary thorough surgery and then the duodenum, temporary abdominal closure, pancreatic and bile duct external drainage simplify surgery, then transferred to the surgical ICU patients after 48h guardianship to be hemodynamically stable patients. Results: 4 cases of severe multiple combined pancreaticoduodenal injury patients degree of injury were more serious, the injury severity of all patients with ISS score more than 16, and the physiological state of the patients already at the limits of the human body. Review of the medical records of patients, the study summarizes collected four cases of severe multiple injuries merger pancreatic of duodenal injury patients during surgery, to the specific application of methods of damage control surgery surgery, and finally all the patients were cured discharged. Conclusion: For severe multiple injuries combined pancreaticoduodenal injury patients, damage control surgery and gastrointestinal phased redevelopment of this surgical treatment can be effective treatment for patients in the life limit. In addition, damage control surgery can significantly reduce mortality in patients with pancreatic duodenal injury, has far-reaching significance in clinical applications.