损伤控制性手术在严重肝脏外伤中的应用

The application of Damage control surgery for severe hepatic trauma

目的探讨损伤控制性手术（DCS）应用于严重肝脏外伤的临床价值，总结治疗经验。方法回顾性分析2005年1月至2009年9月，采用DCS原则治疗18例严重肝脏外伤的手术资料。结果18例患者均经损伤控制性手术治疗SICU复苏后，所有患者都接受再次确定性手术。治愈17例（94．4％），近期并发症发生率为27．8％（再出血1例，再次手术止血。膈下感染＋胆漏1例，应激性溃疡1例，胆漏2例）。死亡1例（5．6％），死亡原因与手术无关。结论符合DCS指征的严重肝脏外伤的患者，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 value of damage control surgery（DCS） and To study the experience of the treatment for severe hepatic trauma. Methods A retrospective analysis was done on preference of 18 patients with severe hepatic trauma under DCS treatment from Jan,2005 to Sep,2009. Results DCS were performed in all 18 patients, and all patients were performed reoperations after damage control resuscitation therapy in surgical intensive care unit（SICU）. The cure rate was 94.4% with 17 cases. The rate of complication incidence was 27.8% （re-bleeding： 5.6% with 1 case after reoperations, subphrenic abscess and biliary fistula： 5.6% with 1 case, stress ulcer ：5.6% with 1 case, biliary fistula ： 11.1% with 2 cases）, and all healed by conservative treatments. The mortality rate was 5.6% with 1 case. and it didn＇ t relate to DCS. Conclusion Considera- tion 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 modus is the key management.