损伤控制性手术治疗严重肝脏创伤(附32例回顾性分析)

Damage control surgery (DCS) for severe hepatic trauma:a retrospective analysis of 32 cases

目的探讨损伤控制性手术(DCS)治疗严重肝脏创伤的临床价值,以总结手术经验。方法回顾性分析1999年8月至2006年8月,采用DCS原则治疗32例严重肝脏创伤的手术资料和后续治疗的情况。结果32例病人均经损伤控制性手术治疗。SICU复苏后,所有病人均接受相应形式的再次确定性手术。治愈28例(87.5%),再次手术术后出现肝脓肿、胆瘘各1例(各为3.1%),经保守治疗痊愈;死亡4例(12.5%),死亡原因与手术无关。结论符合DCS指征的严重肝脏创伤的病人,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。

Objective To explore the current management strategy and effect of damage control surgery （DCS） for severe hepatic trauma. Methods The clinical data of 32 patients with severe hepatic trauma were selected as the object of this study. A retrospective analysis was done on preference of DCS and perioperative therapies. Results DCSs were performed in all 32 patients,and all patients were performed reoperations after therapies at surgical intensive care unit （SICU）. The cure rate was 87. 5% with 28 cases. The complications incidence was as low as 6. 2% （ liver abscess ：3.1% with 1 case, biliary fistula：3.1% with 1 cases）after reoperations, and all healed by conservative treatments. The mortality rate was 12. 5% ,and it did＇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 moduses is the key management.