• 蕪湖市第二人民醫(yī)院急診外科(安徽蕪湖 241000);

目的  探討損傷控制外科(DCS)理念在肝臟破裂救治中的作用。
方法  收集2009年1月至2012年5月期間我院急診外科收治的62例外傷致肝臟破裂患者的臨床資料,比較DCS理念指導(dǎo)前(傳統(tǒng)組)與DCS理念指導(dǎo)后(DCS組)急診肝臟破裂救治的療效。
結(jié)果  DCS組的保守治療率明顯高于傳統(tǒng)組 〔26.47% (9/34)比7.14% (2/28),P<0.05〕,2組間保守治療成功率比較差異無(wú)統(tǒng)計(jì)學(xué)意義〔100% (9/9)比100% (2/2),P>0.05〕;DCS組的死亡率及術(shù)后并發(fā)癥發(fā)生率較傳統(tǒng)組明顯降低〔死亡率:4.00% (1/25)比19.23% (5/26),P<0.05;并發(fā)癥發(fā)生率:32.00% (8/25)比61.54% (16/26),P<0.05〕;2組手術(shù)患者住院時(shí)間、出血量、輸血量、手術(shù)時(shí)間及住院費(fèi)用比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。
結(jié)論  DCS理念指導(dǎo)下制定出的新的搶救措施,能夠明顯降低肝臟破裂的死亡率及術(shù)后并發(fā)癥的發(fā)生率。

引用本文: 徐慶春,王晨,王振宇,潘劉奎,吳軍. 損傷控制外科理念在肝臟破裂治療中的臨床應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2013, 20(8): 943-945. doi: 復(fù)制

1. Grand’Maison S, Sauvé N, Weber F, et al. Hepatic rupture in hemolysis, elevated liver enzymes, low platelets syndrome[J]. Obstet Gynecol, 2012, 119(3):617-625.
2. Tinkoff G, Esposito TJ, Reed J, et al. American associationfor the surgery of trauma organ injury scaleⅠ:spleen, liver, and kidney, validation based on the national trauma data bank[J]. J Am Coll Surg, 2008, 207(5):646-655.
3. 美國(guó)機(jī)動(dòng)車醫(yī)學(xué)促進(jìn)會(huì)(AAAm). 重慶市急救醫(yī)療中心譯.簡(jiǎn)明損傷定級(jí)標(biāo)準(zhǔn)(2005修訂本) [M]. 重慶:重慶出版社, 2005:16.
4. Hawkins ML, Wynn JJ, Schmacht DC, et al. Nonoperative management of liver and/or splenic injuries:effect on resident surgical experience[J]. Am Surg, 1998, 64(6):552-557.
5. 皮執(zhí)民, 李鐵鋼, 唐中華, 等. 267例外傷性肝破裂的處理[J].湖南醫(yī)科大學(xué)學(xué)報(bào), 1998, 23(5):486-488.
6. 吳在德, 吳肇漢. 外科學(xué)[M]. 北京:人民衛(wèi)生出版社, 2003:426.
7. 彭和平. 腹部損傷診治進(jìn)展[J]. 創(chuàng)傷外科雜志, 2003, 5(1):77-79.
8. 吳在德. 外科學(xué)[M]. 第6版. 北京:人民衛(wèi)生出版社, 2006:422.
9. Stone HH, Strom PR, Mullins RJ. Management of the majorcoagulopathy with onset during laparotomy[J]. Ann Surg, 1983,.
10. 邢建橋, 陳域, 付京, 等. 腹腔鏡在腹部外傷診治中的作用[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(7):761-763.
11. Ribeiro Jr MAF, Papaiordanou F, Gonçalves JM, et al. Spontaneous rupture of hepatic hemangiomas:A review of the literature[J]. World J Hepatol, 2010, 2(12):428-433.
12. Vigil-De Gracia P, Ortega-Paz L. Pre-eclampsia/eclampsia and hepatic rupture[J]. Int J Gynaecol Obstet, 2012, 118(3):186-189.
13. Dirkmann D, Radü-Berlemann J, Görlinger K, et al. Recombinant tissue-type plasminogen activator-evoked hyperfibrinolysis is enhanced by acidosis and inhibited by hypothermia but still can be blocked by tranexamic acid[J]. J Trauma Acute Care Surg, 2013, 74(2):482-488.
14. Ho CL, Fu YC, Lin CC, et al. Transcatheter therapy of Budd-Chiari syndrome in a child after liver transplantation:report of one case[J]. Acta Paediatr Taiwan, 2007, 48(5):276-279.
15. (5):532-535.
  1. 1. Grand’Maison S, Sauvé N, Weber F, et al. Hepatic rupture in hemolysis, elevated liver enzymes, low platelets syndrome[J]. Obstet Gynecol, 2012, 119(3):617-625.
  2. 2. Tinkoff G, Esposito TJ, Reed J, et al. American associationfor the surgery of trauma organ injury scaleⅠ:spleen, liver, and kidney, validation based on the national trauma data bank[J]. J Am Coll Surg, 2008, 207(5):646-655.
  3. 3. 美國(guó)機(jī)動(dòng)車醫(yī)學(xué)促進(jìn)會(huì)(AAAm). 重慶市急救醫(yī)療中心譯.簡(jiǎn)明損傷定級(jí)標(biāo)準(zhǔn)(2005修訂本) [M]. 重慶:重慶出版社, 2005:16.
  4. 4. Hawkins ML, Wynn JJ, Schmacht DC, et al. Nonoperative management of liver and/or splenic injuries:effect on resident surgical experience[J]. Am Surg, 1998, 64(6):552-557.
  5. 5. 皮執(zhí)民, 李鐵鋼, 唐中華, 等. 267例外傷性肝破裂的處理[J].湖南醫(yī)科大學(xué)學(xué)報(bào), 1998, 23(5):486-488.
  6. 6. 吳在德, 吳肇漢. 外科學(xué)[M]. 北京:人民衛(wèi)生出版社, 2003:426.
  7. 7. 彭和平. 腹部損傷診治進(jìn)展[J]. 創(chuàng)傷外科雜志, 2003, 5(1):77-79.
  8. 8. 吳在德. 外科學(xué)[M]. 第6版. 北京:人民衛(wèi)生出版社, 2006:422.
  9. 9. Stone HH, Strom PR, Mullins RJ. Management of the majorcoagulopathy with onset during laparotomy[J]. Ann Surg, 1983,.
  10. 10. 邢建橋, 陳域, 付京, 等. 腹腔鏡在腹部外傷診治中的作用[J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(7):761-763.
  11. 11. Ribeiro Jr MAF, Papaiordanou F, Gonçalves JM, et al. Spontaneous rupture of hepatic hemangiomas:A review of the literature[J]. World J Hepatol, 2010, 2(12):428-433.
  12. 12. Vigil-De Gracia P, Ortega-Paz L. Pre-eclampsia/eclampsia and hepatic rupture[J]. Int J Gynaecol Obstet, 2012, 118(3):186-189.
  13. 13. Dirkmann D, Radü-Berlemann J, Görlinger K, et al. Recombinant tissue-type plasminogen activator-evoked hyperfibrinolysis is enhanced by acidosis and inhibited by hypothermia but still can be blocked by tranexamic acid[J]. J Trauma Acute Care Surg, 2013, 74(2):482-488.
  14. 14. Ho CL, Fu YC, Lin CC, et al. Transcatheter therapy of Budd-Chiari syndrome in a child after liver transplantation:report of one case[J]. Acta Paediatr Taiwan, 2007, 48(5):276-279.
  15. 15. (5):532-535.