外科理论与实践

外科理论与实践 ›› 2018, Vol. 23 ›› Issue (02): 155-157.doi: 10.16139/j.1007-9610.2018.02.015

• 论著 • 上一篇    下一篇

损伤控制理念在腹部急诊与外伤中的应用经验（附120例报告）

韩意a, 黄梁a, 史霆a, 刘远滨a, 许臻晔a, 隋亮a, 於平a, 夏怡a, 耿志超a, 毛恩强b, 王晓彦a   

  1. 上海交通大学医学院附属瑞金医院a. 急诊创伤外科,b. 急诊科,上海 200025
  • 收稿日期:2017-12-14 出版日期:2018-03-25 发布日期:2020-07-25
  • 通讯作者: 王晓彦,E-mail: thyroidwxy@hotmail.com

Damage control surgery for patients with acute abdomen and abdominal trauma：a report of 120 cases

HAN Yia, HUANG Lianga, SHI Tinga, LIU Yuanbina, XU Zhenyea, SUI Lianga, YU Pinga, XIA Yia, GEN Zhichaoa, MAO Enqiangb, WANG Xiaoyana   

  1. a. Department of Emergency and Trauma Surgery, b. Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2017-12-14 Online:2018-03-25 Published:2020-07-25

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摘要： 目的 探讨损伤控制理念在腹部外伤与继发性腹膜炎病人中的应用价值。方法 回顾性分析2008年1月至2013年2月应用损伤控制手术救治120例腹部急诊与创伤病人的临床资料。结果 共完成消化道穿孔、继发性腹膜炎病人急诊溃疡穿孔修补术97例,十二指肠造瘘5例,平均手术时间（65±12） min,平均术中出血量（50±21） mL。无围术期死亡发生。术后并发症包括肺部感染8例,切口感染4例,无消化道漏、腹腔感染的发生。完成腹部损伤病人十二指肠造瘘术6例,胰腺损伤快速止血、清创及引流术5例,创伤性肝破裂肝深部缝扎及大网膜填塞术7例。平均手术时间为（100±28） min,术中平均出血量（250±65） mL。8例病人术后入ICU复苏。1例严重胰腺损伤病人术后3 d死亡。围术期并发症包括肺部感染4例,肾功能不全2例,胰漏1例,胆漏1例,肝脓肿1例。结论 行损伤控制手术病人,围术期死亡率和并发症发生率低。在外科创伤和急诊病人中疗效满意。

关键词: 腹部创伤, 外科急诊, 损伤控制外科, 死亡率, 并发症

Abstract: Objective To evaluate the results of damage control surgery in the treatment of abdominal trauma and secon-dary peritonitis. Methods The data of 120 patients with abdominal trauma or acute abdomen undergoing damage control surgery from January 2008 to February 2013 were reviewed. Results For the patients with peptic ulcer perforation and secon-dary peritonitis, surgical repair was performed in 97 cases and duodenostomy in 5 cases. Operative time was (65± 12) min and blood loss was (50± 21) mL. There was no perioperative mortality, digestive tract leakage and abdominal infection. Pulmonary infection was found in 8 cases and wound infection in 4 cases. Duodenostomy was done for 6 cases with duodenal trauma. Surgical haemostasis and debridement and drainage were given for 5 cases with pancreatic trauma. Suture haemostasis combined with filling omentum majus was performed for 7 cases with liver traumatic rupture. Operative time was (100± 28) min and blood loss was (250± 65) mL. Eight cases were treated at ICU postoperatively for rehabilitation. One case with severe pancreatic trauma died 3 days after operation. Perioperative complications included pulmonary infection in 4 cases, renal dysfunction in 2 cases. Pancreatic leak and biliary leak and hepatic abscess were each 1 case. Conclusions The perioperative morbidity and mortality of the patients could be lower when damage control surgery was used. It is an effective approach for the patients with abdominal trauma and acute abdomen.

Key words: Abdominal trauma, Surgical emergency, Damage control surgery, Mortality, Complication

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