损伤控制性外科在门静脉高压症治疗中的应用

目的 探讨损伤控制性外科(damage control surgery,DCS)在门静脉高压症手术中的应用.方法 分析2003年1月～2008年12月笔者医院收治的急诊和择期手术的门静脉高压症患者48例,急诊手术15例,择期手术33例,手术方式为断流术34例、分流术4例、断流和分流联合手术10例.结果 所有病例均经DCS治疗,14例(29.2%)发生并发症,其中术后腹腔出血2例、切口感染3例,肝性脑病3例,门静脉血栓3例,胸腔积液6例,其中死亡2例(4.2%).随访3年内未有再出血患者.结论 门静脉高压症患者在损伤控制理念的指导下行充分的术前准备、适宜的手术治疗方式以及术后处理,可以取得良好的治疗效果.

Application of Damage Control Surgery (DCS) in Portal Hypertension Operation

ObjectiveTo study the application of damage control surgery(DCS) in the portal hypertension operation.MethodsThe clinical data of 48 portal hypertension patients who admitted to Wujin hospital from Jan 2003 to Dec 2008 were analyzed retrospectively.Emergency operation was performed in 15 cases and selective operation was performed in 33 cases. In all cases,34 were treated with portaazygous devascularization,4 with selective shunt and portasystemic shunt,10 with combining portasystemic shunt and portaazygous devascularization.ResultsDCS was performed in all 48 patients.The complication rate was 29.2%(14 cases),including intra-abdominal hemorrhage (2 cases),incision infection(3 cases),hepatic encephalopathy (2 cases),portal vein thrombosis(3 cases),esophageal leakage (6 cases). Mortality rate was 4.2%(2 cases).No patients rebleed in three years.ConclusionIn the patiens of portal hypertension , sufficient preoperative preparation,eligible operative management and postoperative management will achieve good results.