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Objective To investigate the efficacy of damage control surgery for severe abdominal trauma.Methods The clinical data of 82 cases with severe abdominal trauma who received damage control surgery (DCS group) were retrospectively analyzed.The treatment conditions and treatment effect were analyzed.Another 82 cases with abdominal trauma who were not given damage control operation were considered as the control group.Results In DCS group,71 cases improved,the effective rate was 86.6％;11 cases deaths,mortality was 13.4％.4 cases had severe liver rupture,36h after surgery died of multiple organ failure ;3 cases of colon damage,1 d concurrent infections in the postoperative shock and died ;3 cases of retroperitoneal hematoma complicated with coagulopathy,died 20h after operation.In control group,82 cases of abdominal trauma patients after conventional treatment,73 cases improved,and the effective rate was 89.0％ ;9 deaths,mortality was 10.9％.71 patients of DCS group after resuscitation after ICU oxygen saturation,temperature,PH value,PT value and ICU resuscitation significantly improved compared with before treatment,the differences were statistically significant(t =2.467,2.449,2.738,2.453,all P ＜ 0.05),compared with the control group,the differences were not statistically significant (t =1.303,1.312,1.341,1.325,all P ＞ 0.05).Conclusion Damage control surgery for severe abdominal trauma achieved good effect,it is an effective treatment for severe abdominal trauma.
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Objective To analyze the methods and strategy of treatment for multiple injuries in the use of damage control operation, and improve the treatment level and cure rate for multiple injuries.Method From March 2005 to March 2009, 21 patients with multiple injuries were treated by damage control strategy and performed the determinacy operation after the resuscitation in ICU. Results In 21 patients, 16 cases (76.2%) were cured and 5 cases (23.8%) were dead. The injury severity score of 5 dead cases were exceeded 35 points. Conclusions In the strategy of damage control operation, the surgical operation is considered to be a part of the total resuscitative procedure, not the ending of treatment. To those multiple injuries patients, it is safe and effective to perform the damage control operation. It has practical value in clinical treatment.
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Objective To Summarize experiences in the treatment of serious injury of pancreas using damage control laparotomy. Methods Retrospectively analyze the choice of surgical method and follow-up treatments on 38 patients cured by DCL,who were in serious injury of pancreas. Results 12 cases(32%) were stanched, surgical debrided and drainage quickly,6 cases(16%) were treated with improved Cogbill operation,and 20 cases(S3% ) were treated with pancreateduodenectomy without reconstruction of enteron. After recovery in SICU, all patients were treated with deterministic operation again. Totally 4 cases(11%) died,with no relation with surgical operation,and 34 cases (89%) were cured. Pancreatic fistula occurred in 4 patients(11% ) ,all of which have been cured with conservative treatment. Conclusion Patients with serious injury of pancreas in accordance with DCL, should choose proper method and take fractionated operation,based on different places and extent of the injury of pancreas.
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Objective To explore the management strategy of damage control operation(DCO) for extrahepatic bile duct injury.Methods Clinical data of 15 cases with extrahepatic bile duct injury from June 2002 to September 2007 were selected as the object of this study.Results DCO was performed in all of 15 patients,then all cases were underwent reoperation after surgery intensive care unit resuscitation.All cases survived.Two cases(13.3%) occurred biliary fistula and 1 case(6.7%) occurred intestinal fistula of colon after reoperation,2 cases(13.3%)occurred infection and disruption of incisional wound,and 1 case(6.7%) occurred acute liver function failure.All complications were cured by drainage,symptomatic and supportive treatment.The cure rate of these 15 cases was 100%.There were no stricture of bile duct and correlative complications during 28 months of median follow-up.Conclusion To increase survival rate and reduce complications,severe trauma patients with extrahepatic bile duct injury should be made positively under DCO and choose eligible operations modus.
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Objective To explore the current management strategy and effect of damage control operation(DCO)for severe pancreatic trauma. Methods The clinical data of 19 cases with severe pancreatic trauma were selected as the object of this study.A retrospective analysis was done on preference of DCO moduses and perioperative therapies.Results Operations were performed in all 19 patients including six cases(32%) treated with rapid surgical haemorrhage control,wound excision and drainage,three(11%) with Cogbill operation and 10(53%) with Whipple operation without reconstituted digestive tract.Then,all cases were under reoperations after SICU resuscitation.Death was caused by associated organs injuries and secondary infection,with mortality rate of 11%.The pancreatic fistula occurred in two cases(11%) that were healed by conservative treatments.Conclusion For severe pancreatic trauma cases in accordance with DCO indications,active and reasonable operation should be done according to location and degree of pancreas injury.