钢筋致胸腹会阴联合伤多学科协作救治1例并文献复习

Multidisciplinary Collaborative Management of Combined Thoraco-Abdominoperineal Injury Caused by a Steel Bar: A Case Report and Literature Review

摘要: 胸腹会阴贯通伤伤情危重、致死率高，常合并多脏器损伤、重度污染与失血性休克。本文回顾1例42岁男性高处坠落致钢筋胸腹会阴贯通伤患者的多学科协作救治全过程。患者入院伴失血性休克，完善胸腹部CT三维重建明确异物走行，肝胆、胸外、ICU等多学科联合制定损伤控制手术方案，一期行胸腹腔脏器修补、异物取出；术后并发多重耐药菌感染、十二指肠残端瘘、急性肾损伤等并发症，经阶梯抗感染、穿刺引流、二次手术、创面负压封闭引流及序贯营养支持等综合治疗，患者痊愈出院，随访5个月生活基本恢复正常。本例证实规范MDT救治、损伤控制手术与个体化并发症管理可显著提升此类重症创伤救治成功率。

Abstract: Thoracoabdominal-perineal penetrating injury is a critical condition with a high mortality rate, often complicated by multi-visceral injuries, severe contamination and hemorrhagic shock. This article reviews the whole multidisciplinary collaborative treatment process of a 42-year-old male patient suffering from steel-bar thoracoabdominal-perineal penetrating injury due to a fall from height. The patient was admitted with hemorrhagic shock. Three-dimensional CT reconstruction of the chest and abdomen was performed to clarify the path of the foreign body. Specialists from hepatobiliary surgery, thoracic surgery, ICU and other departments jointly formulated a damage control surgical protocol. Primary surgery was conducted to repair thoracic and abdominal viscera and remove the foreign body. Postoperative complications including multidrug-resistant bacterial infection, duodenal stump fistula and acute kidney injury occurred. After comprehensive interventions such as stepwise anti-infection therapy, puncture drainage, reoperation, vacuum sealing drainage of wounds and sequential nutritional support, the patient recovered and was discharged. Five-month follow-up showed he basically returned to normal life. This case verifies that standardized MDT treatment, damage control surgery and individualized management of complications can markedly improve the survival rate of patients with such severe trauma.