损伤控制技术在严重肝外伤治疗中的应用（附39例报告）

Application of damage control surgery in the treatment of severe hepatic trauma： A clinical analysis of 39 cases

目的探讨损伤控制技术在严重肝脏外伤治疗中的临床应用价值。方法回顾性分析2005年3月至2011年6月收治的39例严重肝外伤病人的临床资料，其中严重肝外伤Ⅲ级20例，Ⅳ级13例，V级6例。所有病人均应用损伤控制性手术（DCS）策略进行治疗。结果全组治愈35例，死亡4例（10％），死亡原因为失血性休克及多脏器功能衰竭。术后再次出血4例，经肝动脉栓塞治疗出血停止，其它并发症包括切口感染4例，肺部感染4例，胸腔积液3例，膈下脓肿2例，胆瘘1例，胰瘘1例，应激性溃疡1例，均经保守治疗痊愈。结论合理应用损伤控制技术能有效降低严重肝外伤的病死率和并发症。

Objective To explore the clinically applied value of the damage control surgery （DCS） in the treatment of severe hepatic trauma. Methods The clinical data of 39 patients with severe hepatic trauma in our hospital from March 2005 to June 2011 were retrospectively analyzed, including 20 cases of grade m ,13 cases of grade IV ,and 6 cases of grade V. All patients were subjected to DCS strategy for surgery. Results In all cases, 35 cases were cured,and 4 died with mortality rate being 10 %. The causes of death were hemorrhagic shock and multiple organ failure. The bleeding was successfully terminated in 4 cases of postoperative re-bleeding by selective hepatic artery embolization. Complications included wound infection in 4 cases, lung infection in 4 cases, pleural effusion in 3 cases, subphrenic abscess in 2 cases, bile leakage in 1 case, pancreatic leakage in 1 case and stress ulcer in 1 case. All complications were cured by conservative treatment. Conclusion Rational application of DCS strategy for surgery reduces mortality and complications effectively in severe hepatic trauma.