Brenner Megan, Bochicchio Grant, Bochicchio Kelly, Ilahi Obeid, Rodriguez Eduardo, Henry Sharon, Joshi Manjari, Scalea Thomas
R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA.
Arch Surg. 2011 Apr;146(4):395-9. doi: 10.1001/archsurg.2010.284. Epub 2010 Dec 20.
Damage control laparotomy (DCL) has beneficial effects on the long-term morbidity and survival of trauma patients.
Prospective study.
Level I trauma center.
Eighty-eight trauma patients who were admitted during a 3-year period (January 1, 2000, through December 31, 2003) underwent damage control laparotomy and were subsequently followed up (January 1, 2001, through December 31, 2008).
Damage control laparotomy.
Major and long-term complications, lengths of stay, mortality, readmissions, subsequent surgical procedures, activities of daily living, and return to work.
On admission, the mean age and Injury Severity Score were 33 years and 34, respectively. Of the 88 patients, 66 (75%) were male; 46 patients had blunt injuries and 42 had penetrating injuries. Liver was the most common injury (63 patients), followed by bowel (34), spleen (33), major vessel (19), and pancreas (10). The mean admission pH and temperature were 7.19 and 34.4°C, respectively, with 21.5 U of packed red blood cells transfused. The mean (SD) number of initial abdominal operations was 4.6 (2.5) per patient, with an overall mortality of 28% (25 patients). Intensive care unit and hospital lengths of stay were 18 (15) and 32 (20) days, respectively. Of the 63 patients who survived, 58 underwent intra-abdominal closure with polyglactin mesh. During the study, 44 intra-abdominal infections and 18 enterocutaneous fistulas were diagnosed. All 63 survivors were readmitted at least once. There were a total of 186 readmissions and 92 subsequent surgical procedures. Ventral hernia repair (66 readmissions) was the most common reason for readmission, followed by infection (41) and fistula management (29). There was 0% mortality for patients who survived the preliminary hospitalization. Of the 63 surviving patients, 51 (81%) reported that they had gone back to work and resumed normal daily activities.
Although damage control laparotomy is associated with a significant complication and readmission rate, its overall benefit is indisputable.
损伤控制剖腹术（DCL）对创伤患者的长期发病率和生存率有有益影响。
前瞻性研究。
一级创伤中心。
88例创伤患者在3年期间（2000年1月1日至2003年12月31日）接受了损伤控制剖腹术，并随后进行了随访（2001年1月1日至2008年12月31日）。
损伤控制剖腹术。
主要和长期并发症、住院时间、死亡率、再入院率、后续手术、日常生活活动能力及恢复工作情况。
入院时，平均年龄和损伤严重度评分分别为33岁和34分。88例患者中，66例（75%）为男性；46例为钝性伤，42例为穿透伤。肝脏是最常见的损伤部位（63例患者），其次是肠道（34例）、脾脏（33例）、大血管（19例）和胰腺（10例）。入院时平均pH值和体温分别为7.19和34.4°C，输注浓缩红细胞21.5单位。每位患者初始腹部手术的平均（标准差）次数为4.6（2.5）次，总死亡率为28%（25例患者）。重症监护病房和住院时间分别为18（15）天和32（20）天。63例存活患者中，58例采用聚乙醇酸网片进行腹腔关闭。研究期间，诊断出44例腹腔感染和18例肠皮肤瘘。所有63例幸存者均至少再次入院一次。总共186次再入院和92次后续手术。腹疝修补术（66次再入院）是再入院最常见的原因，其次是感染（41次）和瘘管处理（29次）。初步住院存活的患者死亡率为0%。63例存活患者中，51例（81%）报告已恢复工作并恢复正常日常活动。
虽然损伤控制剖腹术与显著的并发症和再入院率相关，但其总体益处是无可争议的。
