CAJ | 학술논문

目的探讨损伤控制外科在急性肠系膜动脉闭塞性疾病(acute superior mesenteric occlusion,ASMO)中的应用和治疗价值.方法回顾性总结天津市人民医院普通外科2008年6月至2012年5月间手术治疗的ASMO 17例患者的临床资料,17例患者均经CT和(或)血管造影(digital subtraction angiography,DSA)诊断为ASMO;将17例分为两组,A组7例为损伤控制组,主要治疗为早期介入治疗、手术中尽量减少手术时间、肠管外置、补片暂时性关腹等,B组10例为常规手术治疗组.对比两组患者的治疗效果、手术时间、肠管切除长度、手术并发症及死亡率.术后在门诊随访6个月至5年.结果 17例患者死亡5例;发生手术并发症8例.A组和B组平均手术时间分别是(97±42) min和(236±137) min(t=-4.72,P＜0.01);肠管切除平均长度分别是(114±94) cm和(229 ±93) cm(t=-2.49,P=0.03);发生并发症分别为1例、7例(Fisher精确检验P=0.05);死亡分别为1例、4例(Fisher精确检验P=0.345). 结论损伤控制未能明显降低急性肠系膜动脉闭塞性疾病死亡率,但合理使用损伤控制可以有效缩短手术时间,降低手术并发症的发生.
목적 탐토손상공제외과재급성장계막동맥폐새성질병(acute superior mesenteric occlusion,ASMO)중적응용화치료개치.방법 회고성총결천진시인민의원보통외과2008년6월지2012년5월간수술치료적ASMO 17례환자적림상자료,17례환자균경CT화(혹)혈관조영(digital subtraction angiography,DSA)진단위ASMO;장17례분위량조,A조7례위손상공제조,주요치료위조기개입치료、수술중진량감소수술시간、장관외치、보편잠시성관복등,B조10례위상규수술치료조.대비량조환자적치료효과、수술시간、장관절제장도、수술병발증급사망솔.술후재문진수방6개월지5년.결과 17례환자사망5례;발생수술병발증8례.A조화B조평균수술시간분별시(97±42) min화(236±137) min(t=-4.72,P＜0.01);장관절제평균장도분별시(114±94) cm화(229 ±93) cm(t=-2.49,P=0.03);발생병발증분별위1례、7례(Fisher정학검험P=0.05);사망분별위1례、4례(Fisher정학검험P=0.345). 결론 손상공제미능명현강저급성장계막동맥폐새성질병사망솔,단합리사용손상공제가이유효축단수술시간,강저수술병발증적발생.
Objective To investigate the outcome of damage control sugery in patients with acute superior mesenteric occlusion (ASMO).Methods Seventeen patients with acute superior mesenteric occlusion from June 2008 to May 2012 were reviewed retrospectively.Diagnosis was confirmed by CT and/or DSA.Patients were divided into two groups:seven patients in damage control group (shortening surgical time,bowel exteriorization,temporary abdominal closure) ; ten patients in conventional surgical treatment group.The treatment outcomes of the two groups were compared.The survival of all patients was followed up for 6 months to 5 years at outpatient clinic.Results The overall mortality rate was (5/17) and surgical complications rate was (8/17).Operation time was (97 ±42) min and (236 ± 137) min(t =-4.72,P ＜0.01,P ＜ 0.05) respectively in damage control group and conventional surgical treatment group.Intestine resection length was (114 ± 94) cm and (229 ± 93) cm (t =-2.49,P =0.03,P ＜ 0.05) respectively.Complications rate was (1/7) and (7/10) (Fisher's dxact test P =0.05,P ≤0.05) respectively; mortality was (1/7) and (4/10) (Fisher's dxact test P =0.34,P ＞ 0.05) respectively.Conclusions Although damage control does not significantly reduce mortality,but the rational use of damage control can effectively reduce operation time,shorten intestine resection length and decrease surgical complications.