严重肝脏损伤的损害控制性手术治疗

目的探讨损害控制性手术(DCO)治疗严重肝脏损伤的经验。方法回顾分析2008年5月~2015年5月期间治疗的83例严重肝脏损伤患者的临床资料。其中男性47例,女性36例;年龄20~74岁,平均32岁。按照美国创伤外科协会(AAST)肝损伤分级标准,其中Ⅲ级31例,Ⅳ级30例,Ⅴ级22例,无Ⅵ级病例。结果 83例严重肝脏损伤患者中58例按DCO原则治疗,经复苏病情稳定后再接受相应术式的再次确定性手术,治愈56例(96.6%),再次手术后出现肝脓肿3例(5.1%)、膈下脓肿1例(1.7%)、胆漏2例(3.4%),经非手术治疗痊愈;死亡2例(3.4%),均死于肺部感染。25例患者按常规方式进行治疗,治愈20例(80.0%),术后再次手术3例(12.0%),肝脓肿3例(12.0%)、膈下脓肿2例(8.0%)、胆漏3例(12.0%),经非手术治疗痊愈;死亡5例,4例死于肺部感染,1例死于严重出血。结论严重肝脏损伤治疗选择损害控制性手术,能达到提高存活率和减少并发症的目的。

Treatment of severe liver trauma with damage control operation

Objective To investigate the effect of the treatment of severe liver trauma with damage control operation ( DCO) .Methods Clinical data of 83 patients with severe liver trauma treated by DCO principle from May 2008 to May 2015 was retrospectively analyzed.There were 47 males and 36 females,with age ranging from 20 to 74 years ( mean 32 years) .According to the American Association for the Surgery Trauma ( AAST) liver trauma grading standards,there were 31 cases of gradeⅢ,30 cases of gradeⅣ,22 cases of gradeⅤ,and no case of gradeⅥ.Results Fifty-eight cases of severe liver trauma were treated by DCO principle,and then received appropriate corresponding definitive surgery after resuscitation.Among them,56 cases (96.5%) were cured;3 cases developed hepatapostema(5.1%),1 case developed subdiaphragmatic abscess(1.7%),and 2 cases developed bile leakage ( 3.4%) after re-operation,and these cases were all cured by conservative treatment;2 cases died because of pulmo-nary infection.Twenty-five cases were treated by conventional treatment,20 of whom(80.0%) were cured;3 cases developed hepatapostema(12.0%),2 case developed subdiaphragmatic abscess(8.0%),3 cases developed bile leakage(12.0%),and these cases were all cured by conservative treatment;5 cases died, 4 of whom died of pulmo-nary infection and 1 case died of massive haemorrhage.Conclusion DCO principle for treatment of severe liver trauma can improve the survival rate and reduce the complications.