Experience Of Damage Control Surgery In The Treatment Of Liver Rupture

Purpose: To study the application of damage control surgery in the treatment ofliver rupture and hemorrhage.Method:27patients with liver rupture and hemorrhage were enrolled from May2003to May2010in our hospital, among which24were males and3were females.Age range18-81years old, and the average age was47.6years old. Among the cases,12were caused by liver injury,9traffic accidents plus3falls from height;14spontaneous rupture of primary liver cancer and1hepatic hemangioma.27cases wereall accompanied by hemorrhagic shock, abdominal paracentesis with coagulated blood,upper abdominal plain and enhanced CT scan suggesting intraperitoneal hemorrhage.Patients were divided into2groups according to treatment, a definitive one stageoperation (C) group and damage control surgery (DCS) group.14cases of definitiveone stage operation group underwent a definitive surgery as an emergency treatment,including13males and1female, age range18-78years, the average age was45.23years;13cases of damage control surgery group underwent damage control surgeryaccording with the treatment principles of damage control surgery, including11males,2females, age range21-81years, average age was48.92years; Using damage controlsurgery and a definitive one stage operation for27patients with rupture of liver fortreatment, observe and compare their mortality, morbidity, injury severity score (ISS),prothrombin time (PT), activated partial thromboplastin time (APTT), lactate clearancetime, blood loss during surgery, recovery time, post operative body temperature andhospitalization time index.Results: definitive surgery group successfully rescued seven cases (50.00%),death in7cases (50.00%), average injury severity (ISS) score of43.11points, the maincause of death as shock and postoperative complications. In definitive surgery group,complications occurred in9cases, in which adult respiratory distress syndrome (ARDS) in5cases, multiple organ failure (MODS) in3cases, disseminated intravascularcoagulation (DIC) in4cases&a biliary fistula in1case. Damage control operationgroup were successful in12cases,1case died (8.33%), injury severity score (ISS)average46.73points, death of the patient due to adult respiratory distress syndrome(ARDS). In Damage control surgery group, complications occurred in3cases,2casesof adult respiratory distress syndrome (ARDS)&1case of subphrenic abscess.Damage control surgery group comparison with definitive surgery group on patientmortality, complication rate, injury severity score (ISS), prothrombin time (PT),activated partial thromboplastin time (APTT), lactate clearance time, temperaturerecovery time and other parameters were significantly improved, with statisticalsignificance (P <0.05).Conclusion: according to the concept of damage control surgery, treatment of13cases of liver rupture and hemorrhage, the incidence of perioperative mortality,complications, injury severity score, serum lactic acid clearance time, temperaturerecovery time, activated partial thromboplastin time and prothrombin time wassignificantly lower than the definitive surgery treatment group. Thus, the damagecontrol surgical approach is feasible, effective, safe&the hemostatically effective.