一站式杂交手术在创伤救治中应用研究初探

Initial study of one stage "hybrid approach" in the treatment of trauma

目的:一站式杂交手术是一种新兴的外科综合技术,其在创伤领域应用尚属空白,初步探讨其在创伤救治中的作用及疗效。方法:利用我院新建的杂交手术室(Hybrid room)平台,2010年9月-2011年5月共救治6例创伤患者,包括股动脉损伤伴感染性假性动脉瘤2例,闭合性左股骨骨折术后股部血肿、钢筋会阴穿通伤后椎管脓肿并椎管-直肠瘘、腹部穿透伤并发金属异物存留、多发伤术后右肾破裂活动性出血并腹腔间隙综合征各1例,评价一站式杂交手术的流程、有关技术和近期疗效。结果:6例创伤患者中,5例成功救治,1例死于创伤后致死三联征(低体温、代谢性酸中毒、凝血病)。结论:一站式杂交手术在创伤领域的应用,是现代高级影像诊断技术、血管腔内技术和传统手术相结合同时、同地用于创伤患者的再评估和复合治疗方法,而不仅局限于同一解剖部位或脏器,而是整个受伤人体,尤其是多发伤、多部位伤。其相对于传统外科手术的应用前景和疗效需要进一步研究。

Objective：To explore the role of new surgery method,one stage ＂hybrid approach＂ in the treatment of trauma.Method：Clinical data of 6 trauma cases received one stage ＂hybrid approach＂ in our hospital from Jul. 2005 to Mar. 2009 were reviewed. These patients included 2 case of femoral arterial injury with infective pesudoaneurysme,hematoma after closed fracture of left femur,spinal canal abscess and rectum fistula after perforating wound of perineum,metal foreign body after perforating abdominal trauma,and hemorrhage of right renal with abdominal compartment syndrome after multiple injury.Imageological diagnosis,combinational treatment of blood vessels intervention and traditional surgery were performed at the same place and the same time.Result：Five patients were healed successfully and one patients was dead because of trauma lethal triad（hypothermia,metabolic acidosis and coagulopathy） .Conclusion：In trauma patients,one stage ＂hybrid approach＂ is a combination of modern senior diagnostic imaging technical,blood vessels intervention and traditional surgery at the same place and the same time for the diagnosis and management,which is not limited in the same organ or anatomic site but the whole injured body,especially the multi-injury. As a novel treatment,it needs further investigation.