损伤控制性外科在急性重症型胆管炎中的运用

目的:探讨损伤控制性外科(DCS)在急性重症型胆管炎(ACST)的应用效果。方法:回顾性分析我院2006年1月至2009年5月因符合DCS纳入标准急诊入我科的36例ACST患者的临床资料。结果:本组36例ACST患者应用包括迅速解除梗阻、感染等简单快速手术,经ICU复苏待生命体征稳定及黄疸消退后再实施确定性手术,其中2例(5%)因全身多器官功能衰竭而死亡;1例(3%)因急性肺梗死死亡,其余33例(92%)均平稳出院。多次胆道狭窄2例(5%)行三次胆道手术后平稳出院,其余患者均在二次手术后恢复,根据回访结果,均未出现胆道梗阻等并发症。结论:对ACST患者遵循DCS原则,运用简短有效的方法,控制原发损伤对机体的继续损害;积极恢复患者的生理稳定状态;分段有序按微创的理念处理致命性创伤,以达到提高存活率和减少并发症的目的。

The Apply of Study of Damage Control Surgery (DCS) in Acute Cholangitis of Severe Type (ACST) Application Effect

Objective:Study of damage control surgery(DCS) in acute cholangitis of severe type(ACST) application effect.Methods: A retrospective analysis of our hospital in 2006 January to 2009 May due to meet DCS standards into emergency in our department of clinical data of 36 patients with ACST.Results:This group of 36 patients with ACST applications include rapid relief of obstruction,infection,simple and rapid operation,the ICU recovery to be stable vital signs and jaundice subsided after the implementation of the deterministic operation,including 2 cases(5%) due to multiple organ failure and death;in 1 cases(3%) due to acute pulmonary infarction death,the remaining 33 cases(92%) were stable discharge.Repeated biliary stricture in 2 cases(5%) three time after biliary tract operation smoothly discharged,the others were in the two operation after the restoration,according to return results,there were no complications such as biliary tract obstruction.Conclusion:To ACST patients,follow the principle of DCS,applying the brief and effective method,control of the primary injury on human body continues to damage;active recovery in patients with physiological steady state;piecewise ordered by minimally invasive concept to handle the fatal wound,so as to improve the survival rate and reduce the complications of purpose.