损害控制外科在腹部锐性损伤伴多发伤诊治中的应用

Damage control surgery in diagnosis and treatment of sharp abdominal injury combined with multiple trauma

目的探讨损害控制外科（DCS）在腹部锐性损伤外科诊治中的作用。方法回顾性分析2005年1月-2014年8月收治60例腹部锐性损伤伴严重多发伤患者，其中男55例，女5例；年龄15～79岁，平均32．08岁。30例采用确定性手术治疗（对照组），30例采用DCS手术治疗（DCS组）。比较两组患者手术前后血流动力学变化、功能改善情况、治愈率及并发症发生率。结果60例多发伤患者中，术后血流动力学指标明显优于术前，研究组治愈29例，死亡1例，治愈率为97％；对照组治愈15例，死亡15例，治愈率为50％。研究组出现并发症5例，发生率为17％；对照组出现并发症12例，发生率为40％。两组治愈率和并发症发生率差异均有统计学意义（P〈0．05）。结论对腹部锐性损伤伴严重多发伤的患者，采取DCS治疗原则，可降低并发症发生率，提高救治成功率。

Objective To evaluate the role of damage control surgery （DCS） in the diagnosis and treatment of sharp abdominal injury combined with multiple trauma. Methods Sixty patients with sharp abdominal injury accompanied by multiple trauma treated from January 2005 to August 2014 were reviewed retrospectively. There were 55 males and 5 females, aged at 15-79 years （ mean, 32.08 years）. Thirty patients underwent definite operative treatment （ control group）, and 30 patients had DCS （ DCS group）. Between-group differences were examined in pre- and post-operative hemodynamic changes, function recovery, cure rate and complication incidence. Results All patients showed improved hemodynamic parameters after operation. The cure rate was 97% （29/30） in DCS group versus 50% （15/30） in control group （P 〈0.05）. Complications were reported in 17% （5） of the patients in DCS group versus 40% （12） of the patients in control group （ P 〈 0.05 ）. Conclusion DCS is associated with decreased rate of complications and increased cure rate in the treatment of sharp abdominal injury combined with multiple trauma.