损伤控制外科理念应用于胰十二指肠损伤的处理

Application of damage control surgery idea in the treatment of severe pancreatic duodenal injury

目的探讨损伤控制外科（DCS）理念在处理危重胰十二指肠损伤时的应用价值。方法回顾性分析2005年3月至2013年1月问在温州市中西医结合医院和温州医学院附属第一医院接受DCS理念处理的19例胰十二指肠损伤患者的临床资料。结果3例经损伤控制性手术及重症监护复苏处理，未再行确定性手术，康复出院。12例经损伤控制性手术及重症监护复苏处理后行确定性手术（远端胰腺空肠Roux-en—Y吻合术、近端十二指肠空肠Roux—en-Y吻合术或胰十二指肠切除术），康复出院。4例（21．1％）在损伤控制性手术后因多器官功能障碍综合征死亡。结论应用DCS理念处理胰十二指肠损伤能获得较满意的临床转归。

Objective To explore the significance of damage control surgery （DCS） in the treatments of severe pancreatieoduodenal injuries. Methods Clinical data of 19 patients with severe pancreaticoduodenal injuries managed with DCS approach in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine and the First Affiliated Hospital of Wenzhou Medical College from March 2005 to January 2013 were analyzed retrospectively. Results Three cases were cured after damage eontrol operation and postoperative ICU resuscitation treatment. Twelve cases underwent definite operations （distal pancreaticojejunal Roux-en-Y anastomosis, proximal duodenojejunal Roux-en-Y anastomosis or pancreaticoduodenectomy） after damage control operation and postoperative ICU resuscitation treatment and cured. Four cases died after damage control operation due to multiple organ failure and the mortality was 21.1%. Conclusion Application of DCS approach can improve the prognosis of patients with severe pancreaticoduodenal injuries.