损伤控制性手术理论在小儿腹部外科危急重症中的应用

Application of damage control surgery in serious pediatric abdominal surgery

摘要:

目的：损伤控制性手术是一种复杂外科问题分期处理的理念。该文探讨损伤控制性手术在小儿腹部外科危急重症中的应用。方法：回顾性分析32例进行损失控制性手术和17例进行常规手术的临床资料，对两组患儿术前的危重评分(CSS)，术后的体温、动脉血pH值、血浆凝血酶原时间（PT）以及转归情况进行比较。结果：两组术前CSS比较差异无显著性(P>0.05)；两组术后动脉血pH值和PT监测比较，差异有显著性（P<0.05）；术后体温监测差异无显著性（P>0.05），但控制组体温恢复趋势较常规组平缓；两组术后最终转归比较，控制组痊愈率明显优于常规组，差异有显著性（84.4% vs 52.9%，P<0.05）。结论：损伤控制性手术在处理小儿腹部外科危重疾病中效果优于常规处理，在小儿腹部外科危急重症的处理中具有重要的意义。［中国当代儿科杂志，2009，11（9）：729-732］

Abstract:

OBJECTIVE: Damage control surgery (DCS) deals with the complex surgical problems by stages. This study investigated the application of DCS in serious pediatric abdominal surgery. METHODS: The clinical data of 49 children with serious abdominal diseases (age: 4 months to 10 years) were retrospectively studied. Of them, 32 children underwent damage control surgery (DCS) and 17 children underwent conventional operation. The preoperative critical severity score (CSS), postoperative temperature, blood pH and prothrombin time (PT), and the treatment outcome were compared between the DCS and the conventional operation groups. RESULTS: No significant difference was found in the preoperative CSS between the two groups. There were significant differences in postoperative blood pH and PT values between the two groups (P<0.05). As for postoperative temperature, there was no statistical difference between the two groups, yet the tendency of temperature recovery in the DCS group was milder than that in the conventional operation group. Twenty-seven children (84.4%) were successfully cured in the DCS group, while 9 children (52.9%) in the conventional operation group (P<0.05). CONCLUSIONS: The curative effect of DCS surpasses the conventional operation in children with serious abdominal diseases, suggesting that DCS is of value in the management of serious pediatric abdominal diseases.［Chin J Contemp Pediatr, 2009, 11 (9):729-732］