损伤控制性外科理念治疗非外伤性大肠穿孔腹腔感染的临床研究

Clinical effect of damage control surgery concept on treatment of abdominal infections caused by non-traumatic extrarectal perforation

目的研究损伤控制性外科(DCS)理念对于治疗非外伤性大肠外穿孔致严重腹腔感染的临床应用,提高临床治疗水平。方法对2006-2013年医院收治的36例非外伤性大肠外穿孔致严重腹腔感染的患者进行的损伤控制性外科理念治疗进行分析,对于患者手术前后的生化指标及临床症状等进行比较。结果对患者手术前及手术后1、2、7d的体温及生化指标进行研究显示,患者在手术前由于休克等原因,体温较低,手术后体温基本恢复正常,腹腔内压力在手术后第1天与术前相比有所升高(P<0.05),从手术后第2天开始降低,第7天恢复正常;对36例患者进行DCS治疗,有32例患者治愈,26例患者接受了再次确定性手术痊愈出院,4例患者死亡。结论损伤控制性外科理念能够提高非外伤性大肠外穿孔致严重腹腔感染患者的救治成功率,效果显著,对非外伤性大肠外穿孔致严重腹腔感染的治疗具有重要意义。

OBJECTIVE To observe the clinical effect of damage control surgery （DCS） concept on treatment of se‐vere abdominal infections caused by non‐traumatic extrarectal perforation so as to improve the level of clinical treatment .METHODS From 2006 through 2013 ,a total of 36 patients with severe abdominal infections‐induced by non‐traumatic extrarectal perforation ,who were treated on the basis of DCS concept ,were recruited in the study , then the biochemical indicators and the clinical symptoms of the patients were observed and compared before and after the surgery .RESULTS The study of the body temperature and the biochemical indicators before the surgery or at 1 ,2 ,and 7 days after the surgery showed that the body temperature was low before the surgery due to the shock and recovered to normal after the surgery ,the intra‐abdominal pressure was elevated on the first day after the surgery as compared with that before the surgery （P〈0 .05） ,and it started to decrease on the second day after the surgery and returned to normal on the seventh day .Among the 36 patients who received the DCS treatment , 32 cases were cured ,26 cases were received the definitive surgery and discharged ,and 4 case died .CONCLUSION The DCS concept can raise the success rate of treatment of the patients with severe abdominal infections induced by non‐traumatic extrarectal perforation and achieve significant effect ,it has great significance in the treatment of se‐vere abdominal infections induced by non‐traumatic extrarectal perforation .