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目的探讨损伤控制手术在严重多发伤合并胰十二指肠损伤中的应用。方法回顾近5年来我院收治的4例严重多发伤合并胰十二指肠损伤的病例资料,总结在4例严重多发伤合并胰十二指肠损伤患者中主动采用损伤控制手术的具体应用方法及效果。结果4例多发伤情较重且合并胰十二指肠损伤的损伤严重度(ISS)评分均>16,并处于生理极限状态,应用损伤控制手术首先进行止血和制止肠内容物的外溢、行消化道未重建的胰十二指肠切除术、胰管及胆管外引流、临时关腹等简化手术,随后送到外科ICU待血液动力学稳定,在监护48h后再次行彻底性手术,均痊愈。结论运用损伤控制手术并分阶段重建消化道,对严重多发伤合并胰十二指肠损伤并处于生命极限的患者是有益的,并可显著地降低胰十二指肠损伤患者的死亡率。
Objective To investigate the application of injury control surgery in severe multiple traumatic injury with pancreaticoduodenal injury. Methods The data of 4 cases of severe multiple traumatic pancreaticoduodenal injury treated in our hospital in recent 5 years were reviewed. The specific application methods of active trauma control surgery in 4 patients with severe multiple trauma and pancreaticoduodenal injury were summarized. And the effect. Results Four patients with multiple injuries and pancreaticoduodenal injuries with severity of injury (ISS) score> 16 were in physiological limit state. The patients underwent trauma control surgery to stop the bleeding and stop the overflow of intestinal contents. Reconstructive pancreaticoduodenectomy of the digestive tract, pancreatic duct and extrahepatic biliary drainage, temporary closure of the abdomen and other simplified surgery, and then sent to the surgical ICU to be hemodynamically stable, again after the custody of 48h thorough surgery, were cured . Conclusion The use of injury-controlled surgery and the reconstruction of the digestive tract in stages are beneficial for patients with severe multiple injuries and pancreaticoduodenal injuries that are at the limit of their life and can significantly reduce the mortality of patients with pancreaticoduodenal injury.