损伤控制手术在治疗严重肝外伤中的临床意义

Clinical significance of damage control surgery in the treatment of severe liver trauma

目的探讨损伤控制性手术（damage control surgery，DCS）在治疗严重肝外伤中的临床应用。方法通过回顾性分析在2000—04～2008—09间我院采用损伤控制性手术治疗出现血流动力学不稳定、低体温、代谢性酸中毒和凝血障碍等情况的26例严重肝外伤（Ⅲ～Ⅵ级）患者的临床资料，总结出严重肝外伤应用损伤控制性手术的适应证、并发症和死亡率。结果26例患者中痊愈21例（治愈率80．2％），死亡5例（死亡率为19．2％），术后共17例发生了各种并发症（占65．4％）。结论对于严重肝外伤出现血流动力学不稳、低体温、代谢性酸中毒和凝血障碍等情况时选择损伤控制性手术不失为比较安全的、稳妥的手术方法，可有效地降低严重肝外伤的死亡率和并发症发生率。

Objective To discuss the clinical significance of damage control surgery （DCS） in the treatment of severe liver trauma. Methods To analyze retrospectively the clinical data of 26 cases with severe liver trauma（ Ⅲ - Ⅵ ） who had the complications of hemodynamic instability, hypothermia, metabolic acidosis, blood coagulation disturbance from April 2000 to September 2008 in order to sum up the operative indication, complications, mortality rate of DCS. Results In 26 cases, 21 cases were cured, 5 cases died. Cure rate was 80. 8%, mortality was 19. 2%. 17 cases had complications （65.4%）. Conclusion DCS is a safe and reliable operative methods for the severe liver trauma cases with complications and it can effectively lower complications and mortality rate.