在选择性手术中管理失控出血:损害控制技术的作用
Atsushi Nanashima1, Takashi Wada1, Fumiaki Kawano1
1Division of Hepato-Biliary-Pancreas Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
International journal of surgery case reports
|February 21, 2025
概括
损伤控制手术 (DCS) 是一种在传统方法失败时在选择性手术期间大量出血的救生干预. 这种方法可以稳定出血性休克和凝血病患者,使复杂病例的结果有利.
科学领域:
- 手术瘤学手术瘤学
- 创伤外科 手术 创伤外科
- 肝胆道手术 肝胆道手术
背景情况:
- 选择性手术中的大量出血带来了重大挑战,往往超过了传统的静血手术的疗效,特别是不受控制的凝血病.
- 损伤控制手术 (DCS) 是创伤护理中一个公认的策略,用于管理出血性休克,凝血病,低温和酸性疾病.
- 在选择性环境中,DCS可以成为意外大量出血的关键干预措施,特别是在生命体征不稳定或腹内压力增加的患者中.
研究的目的:
- 评估损害控制外科手术 (DCS) 在选择性手术期间管理大量手术内出血的疗效.
- 提出案例研究,证明DCS在复杂的手术场景中的成功应用.
- 突出DCS作为在选修程序期间在意外紧急情况中拯救生命的措施的作用.
主要方法:
- 在选择性腹部手术 (结肠癌切除和肝脏切除) 期间出现两种明显的大量出血病例.
- 由于失控出血和血液动力学不稳定,在两种情况下都采用了涉及布包装和开放腹部管理的损害控制手术 (DCS).
- 进行了第二次外科手术,以解决残留出血并促进腹部闭合,其中一例使用了血管内气球阻塞大动脉.
主要成果:
- 两位患者,尽管最初大量出血和凝血病,但在DCS之后的手术干预中幸存下来.
- 案例1涉及上半腹静脉损伤的修复,患者在术后存活了9个月.
- 案例2证明了肝切除和DCS后成功的血液静止和没有肝衰竭的恢复.
结论:
- 在选择性手术期间大量出血和不受控制的凝血病时,传统的静血技术可能不足.
- 损伤控制手术 (DCS) 是一种有价值的,可能挽救生命的方法,用于在选择性手术环境中管理意想不到的大量出血和血液动力学不稳定.
- 在这些情况下,DCS的成功应用支持了其在复杂的选择性手术中的实用性,在复杂的选择性手术中,长时间的手术是不可行的,或者当传统方法失败时.
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