Bashir Masoud M, Abu-Zidan Fikri M
Accident and Emergency Department, Al-Ain Hospital, Al-Ain, UAE.
Eur J Surg Suppl. 2003 Jul(588):8-13.
To review the physiology, indications, technical aspects, morbidity, and mortality of damage control surgery.
Retrospective study of published papers.
Teaching hospital, United Arab Emirates.
A MEDLINE search on damage control surgery for the years 1981-2001. Further articles were retrieved from the references of the original articles.
The indications for damage control surgery are: the need to terminate a laparotomy rapidly in an exsanguinating, hypothermic patient who had developed a coagulopathy and who is about to die on the operating table; inability to control bleeding by direct haemostasis; and inability to close the abdomen without tension because of massive visceral oedema and a tense abdominal wall. The principles of damage control surgery are: Phase I: laparotomy to control haemorrhage by packing; shunting, or balloon tamponade, or both; control of intestinal spillage by resection or ligation of damaged bowel, or both. Phase II: physiological resuscitation to correct hypothermia, metabolic acidosis, and coagulopathy. Phase III: planned reoperation for definitive repair. Damage control surgery is appropriate in a small number of critically ill patients who are likely to require substantial hospital resources; it has a high mortality (mean 45%, range (10%-69%).
Damage control surgery offers a simple effective alternative to the traditional surgical management of complex or multiple injuries in critically injured patients. Phases I and II can be done at a rural hospital before transfer to a major trauma centre for definitive repair.
回顾损伤控制手术的生理学、适应证、技术要点、发病率及死亡率。
对已发表论文的回顾性研究。
阿拉伯联合酋长国的教学医院。
对1981 - 2001年期间关于损伤控制手术的文献进行医学文献数据库（MEDLINE）检索。从原始文章的参考文献中获取更多文章。
损伤控制手术的适应证为：需要在因凝血功能障碍而出血、体温过低且即将在手术台上死亡的患者中迅速终止剖腹手术；无法通过直接止血控制出血；以及由于大量内脏水肿和腹壁紧张而无法无张力地关闭腹腔。损伤控制手术的原则是：第一阶段：剖腹手术，通过填塞、分流或球囊压迫（或两者同时使用）控制出血；通过切除或结扎受损肠管（或两者同时使用）控制肠内容物外溢。第二阶段：进行生理复苏以纠正体温过低、代谢性酸中毒和凝血功能障碍。第三阶段：计划再次手术进行确定性修复。损伤控制手术适用于少数可能需要大量医院资源的危重病患者；其死亡率较高（平均45%，范围为10% - 69%）。
损伤控制手术为严重受伤患者复杂或多发损伤的传统手术治疗提供了一种简单有效的替代方法。第一阶段和第二阶段可在农村医院完成，然后再转至大型创伤中心进行确定性修复。
