损伤控制外科技术在严重胰腺外伤中的应用

Application of damage control surgery in the treatment of severe pancrentic trauma

目的 探讨DCS在严重胰腺外伤（Ⅲ—Ⅳ级，AAST-OIS分级）救治中的应用效果。方法 对1995年7月-2006年7月应用DCS救治的9例严重胰腺外伤的临床资料进行回顾性分析。结果 9例均立即给予液体复苏、急诊手术控制出血和污染、清创、保存胰腺功能、充分引流、恰当处理合并伤，待生命体征稳定后，再确定手术治疗。7例经用DCS后，情况良好，痊愈出院，1例死于并发坏死性胰腺炎，1例死于合并脑疝。结论 对严重胰腺外伤病人，在复苏同时应尽快采用简单省时的手术挽救生命、控制出血和污染、充分引流、保存胰腺功能，病情稳定后再做相应的手术和治疗，可提高抢救成功率，减少术后并发症。

Objective To study the effect of Damage Coutrol Surgery （DCS） on the treatment of severe pancreatic trauma （Ⅲ-Ⅳ class, AAST-OIS ratings）. Methods A retrospective analysis was made on the clinical data of 9 cases with severe pancrentic trauma treated by DCS from July ,1995 to July,2006. Results Nine case of severe pancrentic trauma were treated by immediate fluid resyscitation and emergency operation,so that to control the bleeding and contamination,perform debridement, keep pancreas function,achieve full drainage aswell as to manage concurrent trauma, The definitive operation was performed as soon as the vital signs became stable. After adopting DOS, 7cases recovered and were discharged, 1 cases dead of severe acute pincreatitis and 1 cases dead of cerebral hernia. Conclusion The successful operative control of bleeding and contemination, fuU drainage ,preservation of pancreas function,during resuscitation and performance of definitive operation after stability of vital signs will contribute a lot to a high curative rate,and the overall morbidity can be reduced.