介入治疗在伴危重症腹部疾病损伤控制性手术中的应用

【摘要】  目的 探讨介入治疗技术在腹部危重症患者损伤控制外科中的应用。方法 124例急性胆囊炎胆石症、肝胆管结石、梗阻性黄疸、脓肿、假性胰腺囊肿、化脓性胆管炎合并严重心脑血管疾病、甲状腺、糖尿病、高血压、血液病行B超引导下介入穿刺安置“S”形猪尾巴管引流，缓解中毒症状，后续治疗内科合并症，症状改善后再行2期手术治疗。结果 共穿刺130次，2次失败，行2期手术76例。好转10例，占8.06%；死亡7例，占5.65%；治愈107例，占86.29%。结论 对腹部外科疾病并有严重合并症患者，应用微创介入技术，贯彻损伤控制外科治疗原则是明智之举。

【关键词】  损伤控制；介入治疗；危重并发症；腹部疾病

Clinical application of interventional procedure in abdominal diseases combined with severe complications for damage control principle      

　　WANG Dadong， JIAO Huabo， TAN Xianglong， et al.
　　Department of Hepatobiliary Surgery， the First Hospital Affiliated to Chinese PLA General Hospital， Beijing 100037
 
　　Abstract   Objective  To study the application of intervertional procedure in abdominal diseases combined with severe complications for damage control principle. Methods  One hundred and twenty-four cases consecutively suffered from acute cholangitis， hepatolithiasis， obstructive jaundice， abscess， pancreatic pseudocyst， cholecystitis respectively combined with severe cardiopulmonary disease， hyperthyroidism， diabetes mellitus， hypertension， haematopathy were performed with interventional procedure and pigtail drainage under B ultrasonic machine guided. Results  Panctures were performed 130 times on 124 patients. Failure occurred 2 times， 76 cases were underwent secondary operation. 10 cases were improved  (8.06%)， 107 cases were recovery (86.29%)， 7 cases died (5.65%). Conclusion  Interventional procedure is a useful technique in damage control surgery， especially for abdominal diseases with severe complications.
 
　　Key words   damage control； interventional procedure； severe complications； abdominal diseases

　　损伤控制外科(damage control surgery，DCS)是20世纪80年代提出并发展起来的一项外科救治原则，主要应用于严重创伤的治疗中，对提高患者的救治成功率起重要作用。然而，这一原则在危重症患者的腹部择期手术中应用较少。我院利用介入微创技术，贯彻这一原则处理伴有危重症的腹部疾病，取得了良好的治疗效果，现报告如下。