【摘要】 目的 探讨损伤控制理论（damage control theory，DCT）在脑动静脉畸形（arteriovenous malformations，AVM）诊断与治疗中的应用意义，以及指导治疗脑AVM的可行性。 方法 依据DCT原则，对2007年3月-2009年3月脑AVM患者进行积极治疗，并分析其治疗结果。 结果 根据DCT原则制订脑AVM患者的治疗方案，控制脑AVM的危险因素，降低其疾病发展风险，患者治疗结果比较满意。 结论 应用DCT原则指导脑AVM患者急性期处理及介入等治疗措施，可以提高患者的生存率，有效控制疾病的危险因素，提高治疗总有效率，具有临床指导意义。【Abstract】 Objective To investigate the significance and feasibility of damage control theory (DCT) in diagnosing and treating cerebral arteriovenous malformations (AVM). Methods According to the disease treatment principle of DCT, 76 patients with AVM diagnosed in our hospital from March 2007 to March 2009 were treated actively, and the treatment results were analyzed. Results The risk factors of AVM was controlled, the development risk of AVM slowed down, and the therapeutic effect was satisfactory. Conclusion According to the DCT principle, we could improve the survival rate of the patients, control the risk factors effectively, and improve the prognosis of the disease. DCT principle is clinically significant to guide the treatment of AVM.
Objective To explore the appl ication of damage control surgery (DCS) strategy in the treatment of severe burn-trauma combined injury. Methods From January 2004 to December 2009, 28 patients with severe burn-trauma combined injury received salvage treatment according to DCS, including 12 cases of burn combining injury at 2 sites, 6 cases ofburn combining injury at 3 sites, and 10 cases of burn combining injury at 4 sites or above. There were 18 males and 10 females with a median age of 39.5 years (range, 8-56 years). The burn area was 15% to 56% of total body surface area. The injury severity score a (ISS) was 25 to 56, and the traumatic index was 17 to 24. Lethal triad syndrome occurred in all patients. Of them, 16 cases were on admission immediatly after first-aid, and 12 cases were thansferred from other hospitals. The time from injury to hospital ization was 20 minutes to 36 hours. All patients were treated by immediate fluid resuscitation and emergent operation to control hemorrhage and contaminations. Biological dressings were used to seal the wounds provisionally. The systemic therapy was carried out as soon as the vital signs of the patients became stable. Results In 26 survivors, 23 achieved wound heal ing by first intention, 3 had a l ittle residual wound at discharge. The hospital ization days were 31 to 398 days (62 days on average). However, 1 patient died of multiple organ failure, another 1 patient died of severe cerebral trauma with refractory shock. Conclusion The DCS strategy is effective in reducing mortal ity of patients with severe burn-trauma combined injury.
Objective To analyze the outcome of patients with abdominal injury (AI) in the Chengdu Army General Hospital within 48 hours after the Wenchuan earthquake, in order to provide evidence for future improvement in emergency response after earthquakes and in the treatment of AI patients. Methods Data on the AI patients within 48 hours after the earthquake were collected from the Information Department of the Hospital. Microsoft EXCEL was used for data input. Results A total of 33 AI inpatients were treated which was 3.1% of the total inpatients. The AI inpatients suffered severe and complex injuries, and one of them died (mortality rate: 3%). Conclusion As a second-line Grade-A hospital,prompt triage is very important to patients who were rescued 48 hours after the earthquake. Reasonable damage control surgery and remedies prepared by medical staff from different specialties after the operations may decrease mortality rate.
目的:通过对严重腹部损伤患者实施损伤控制性手术策略和方法,提高创伤的抢救成功率。方法:回顾分析8 例严重腹部损伤 (ISSgt;16)患者应用损伤控制性手术的策略进行救治的情况,8例患者入院后在积极抗休克急救处理的同时进行急诊剖腹探查手术,初期均采用大纱垫填塞的方法控制出血后关腹,ICU 内复苏后,所有患者都进行了Ⅱ期计划性手术。结果:经过损伤控制性手术救治的严重损伤复苏过程较平稳,腹部并发症得到有效控制。痊愈6 例,死亡2例。术后出现膈下感染1例,胆瘘1例,经引流治疗痊愈。结论:对于符合DCO 指征的严重腹部损伤的患者要尽早、尽快地实施DCO,提高综合治疗水平,根据腹部损伤的部位和程度,采取适宜的再次确定手术的方式,可以有效地降低严重腹部损伤病死率。
目的 探讨损伤控制外科（DCS）理念在肝脏破裂救治中的作用。方法 收集2009年1月至2012年5月期间我院急诊外科收治的62例外伤致肝脏破裂患者的临床资料，比较DCS理念指导前（传统组）与DCS理念指导后（DCS组）急诊肝脏破裂救治的疗效。结果 DCS组的保守治疗率明显高于传统组 〔26.47% （9/34）比7.14% （2/28），P＜0.05〕，2组间保守治疗成功率比较差异无统计学意义〔100% （9/9）比100% （2/2），P＞0.05〕；DCS组的死亡率及术后并发症发生率较传统组明显降低〔死亡率：4.00% （1/25）比19.23% （5/26），P＜0.05；并发症发生率：32.00% （8/25）比61.54% （16/26），P＜0.05〕；2组手术患者住院时间、出血量、输血量、手术时间及住院费用比较差异均无统计学意义（P＞0.05）。结论 DCS理念指导下制定出的新的抢救措施，能够明显降低肝脏破裂的死亡率及术后并发症的发生率。
ObjectiveTo explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage. MethodsBetween January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type Ⅱ and 7 as Gustilo type Ⅲ. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed. ResultsDelayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2. ConclusionEarly internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.
ObjectiveTo explore the application value of damage control in intra-abdominal sepsis. MethodsThe related literatures were searched by searching literatures with " damage control” " damage control resuscitation” damage control surgery”, and " intra-abdominal sepsis”, to made an review. Results Despite significant advances in management and treatment, mortality from intra-abdominal sepsis remained still high. Due to its unique anatomic and microbial environment, initial operation could not completely remove the source of infection and avoid complications. Therefore, it was becoming increasingly popular to utilize a damage control strategy with abbreviated laparotomy and planned reoperations. ConclusionsDamage control is characterized by staged treatment, and is widely accepted used to manage intra-abdominal sepsis.
ObjectiveTo investigate the effect of vascular interventional technique in arterial injuries of damage control surgery.MethodsA retrospective review was made on clinical data of 31 arterial injuries cases who received damage control surgery from March 2011 to June 2018. All cases underwent endovascular therapy for arterial injuries in No. 960 Hospital of Chinese People’s Liberation Army, and then the definitive operation was operated as soon as the vital signs became stable.ResultsThe surgery was successful in all patients, and the operation time was 43–100 min (average of 57 min), the intraoperative blood loss was 50–200 mL (average of 80 mL). Bleeding was successful controlled in 11 cases with covered stents, 9 cases with multiple overlapping bare stents, and 11 cases with spring coil, all cases with shock were improved immediately. There were no perioperative mortality or procedure-related complication occurred. All cases were discharged from hospital smoothly after two-phase surgery. All the patients were followed up for 6 to 24 months [(17±5) months]. Two patients with covered stent lumen stenosis less than 50% as showed by angiography, and no secondary treatment was required. In addition, blood flow patency was kept in the rest of artery, no bleeding occurred in injured artery. During the follow-up period, the collateral vessels of 9 patients treated with multi-layerbare stent overlapping technique were unobstructed. Stent migration, fracture or leakage was not found during the follow-up period. Patients recovered well after definitive surgery, they had good fracture healing with a disability rate of 0.ConclusionRational application of vascular interventional technique in damage control surgery is a safe and effective treatment method for arterial injuries combined with other traumas.