损伤控制性手术在严重肝外伤治疗中的应用体会

Application of damage control surgery for the treatment of severe liver injury

目的探讨损伤控制性手术（damagecontrolsurgery，DCS）在治疗严重肝外伤中的应用价值并总结手术经验。方法回顾性分析我院2002年1月2009年7月间22例严重肝外伤患者预后情况。结果22例患者均采用损伤控制性手术治疗，其中痊愈16例，死亡6例。术后出现肝脓肿2例，胆瘘4例，膈下感染1例，消化道出血1例，均经保守治疗痊愈。结论符合DCS指征的严重肝外伤患者，应积极实施DCS，分次手术治疗，可有效地降低严重肝外伤死亡率。

Objective To evaluate the value of damage control surgery （DCS）in the treatment of severe liver injury. Methods The clinical data of 22 patients with severe liver injury who underwent DCS treatment from January 2002 to July 2009 were retrospectively analyzed. The items for exami- nation included injury degree, operative type, surgical efficiency and postoperative complications. Results Sixteen patients were cured, and 5 died. Hepatic abscess occurred in 2 patients, bile leakage in 4 patients, infra- diaphragmatic infection in 1 patient, and alimentary tract hemorrhage in 1 patient post operation. Conclusion The keys to improve therapy efficacy are selection of rational surgical procedures according to the specific conditions of hepatic injuries. DCS should be actively performed in the patients with se- vere liver injury who meet the indication of DCS. The procedure should be conducted with multiple steps according to the sites and degrees of the injury, which can decrease mortality of severe liver injury effectively.