传统观念认为，任何外科疾症的首次手术治疗是进行确定性修复或重建的最佳时机，但严重创伤病人惊人的病死率，逐渐使人们认识到死亡的原因并非手术失败，而是继创伤及手术后的内环境紊乱、生理功能障碍，最终导致的低体温、凝血功能障碍及酸中毒三联症，又称作为“致死三联征”。严重创伤由于存在必须手术处理的外科情况，损伤控制性外科(damage control surgery，DCS)应运而生，它改变了严重创伤病人一定要在首次手术进行确定性手术的概念，更注重创伤后的临时生命救护和控制病理生理改变，其包括简单快速手术，又称损伤控制性剖腹术(damage control laparotomy，DCL)，术后复苏和再次确定性手术，对严重创伤实施阶段性的治疗能避免严重创伤情况下“致死三联征”协同作用导致的生理上不可逆的损伤。DCL(也称为快速手术)包括：(1)快速控制出血，如临时血管分流、腹腔填塞等；(2)快速控制穿孔的空腔脏器内容物泄露导致的腹腔污染，如破损肠管的残端丝线结扎、闭合器闭合等；(3)实施临时关闭腹腔。其迅速、简单地完成手术，避免确定性手术对机体造成的更大损伤，有利于抗休克、复苏及后送，能更有效、更成功率的完成确定性手术。 虽然DCL的主要任务是快速控制出血，快速控制腹腔污染不是DCS的主要步骤，但其必不可少。既往临床回顾性研究大都集中于腹腔出血填塞和腹腔高压临时开腹，对肠管等空腔脏器的快速夹闭控制污染研究甚少，亦鲜有相关的动物实验研究，其实施大都依赖于个人的经验。没有合适的实验模型是导致其相关研究发展缓慢的一个重要原因。本研究首先建立严重腹部创伤致多发肠管损伤合并“致死三联征”的模型，研究快速控制肠穿孔导致的腹腔污染与传统一期手术相比有何优缺点，并探讨损伤控制处理后再次行确定性手术的最佳时间。 第一部分 严重腹部创伤致多发肠损伤合并“致死三联征”模型的建立 目的：既往的创伤实验模型多数是控制性出血或者非控制型出血合并软组织的损伤或者骨系统的损伤，未能达到“致死三联征”，也没有腹腔污染、腹膜炎或脓毒症。为了适合腹部严重创伤的损伤控制研究，本实验旨在建立多发肠管损伤合并“致死三联征”的严重腹部创伤实验模型，以便用于下一步的实验研究。 方法：6只雌性本地杂种猪，麻醉后，行颈内动静脉置管供监测血流动力学和输液使用。腹部小切口行胃造口、膀胱造瘘后，侧卧后以实验用模拟枪于腹部枪击1次，枪击位置为耻骨联合上20㎝，距腹正中线10㎝。枪击后立即经颈动脉放血，20min内放血约为总血量50%(35ml/㎏)。40min后模拟4h院前阶段，以生理盐水行允许性低血压复苏，维持收缩压(SBP)＞80mmHg或平均动脉压(MAP) ＞60mmHg= SBP＞80mmHg或MAP＞60mmHg时不予补液或放血。院前阶段完毕时，严重腹部创伤合并“致死三联征”模型建立完成。接着可以模拟院内阶段(输血、气管插管、复温)及不同的外科干预(传统手术或DCS)。检测指标：血流动力学参数、动脉血气、凝血参数及血常规。心肌、肺、小肠、肝H&E病理检 结果：枪击后多发肠管损伤、穿孔(8-10处，每只动物相似)导致腹腔污染；肠系膜损伤(1-2处，每只动物相似)导致局部肠管缺血、腹腔出血(＜150ml)；无结肠及肠系膜大血管的损伤。至模型建立完成时(院前复苏结束时)有1只动物死亡，死亡率为16.7%；其余动物生命体征尚稳定，但均自发明显的低体温(33.3±0.5℃)；创伤失血后血流动力学出现典型的休克表现；院前复苏后均有明显的低体温、酸中毒、凝血障碍；病理检查提示心肌、肺、小肠、肝均有明显损伤。 结论：本模型成功模拟“创伤失血性休克、院前复苏阶段、院内阶段”三个阶段，并成功引入“致死三联征”，并且伴有腹腔污染，极具临床相关性。此模型稳定性好，可复制性高，存活动物可以进行下一步实验干预(如一期手术或损伤控制处理等)。 第二部分 比较损伤控制手术和传统手术对全身炎症反应以及早期死亡率的影响 目的：比较严重腹部创伤后行损伤控制手术与传统一期手术对血流动力学、凝血、酸中毒、全身炎症反应、各器官的氧化应激损伤及早期死亡率的影响。 方法：雌性本地杂种猪，麻醉后建立多发肠管损伤合并“致死三联征”的严重腹部创伤实验模型(同第一部分)。接着随机分为2组：传统手术组(CS)或损伤控制组(DCS)(n=6)。院内阶段均采用气管插管后呼吸机辅助呼吸、复温；回输自体血及适量晶体完全复苏。同时行剖腹探查，肠系膜缝扎止血、切除或修补损伤肠管，传统手术组行肠管残端端端吻合，单层24针，冲洗腹腔、7号线双层关闭腹腔；损伤控制组行肠管残端血管钳夹闭、丝线结扎，冲洗腹腔、临时关闭腹腔。记录手术时间、输液量、失血量、小时尿量。术后观察至6h，6h后处死动物取各脏器行相关检查。检测指标：血流动力学参数、动脉血气、凝血酶原时间(PT)、部分促凝血酶原激酶时间(PTT)、外周血心肌磷酸肌酸激酶(CK)、肝谷草转氨酶(AST)。心肌、肺、小肠、肝肿瘤坏死因子(TNF)-α水平、核因子(NF)-κB活性测定以及H&E染色、髓过氧化物酶(MPO)免疫组化染色病理检查。另外2组(n=10)行创伤后24h生存分析。 结果：损伤控制手术较传统手术手术时间短(1.1±0.2h vs 2.4±0.3h)、输液量少(3204±254ml vs 3756±313ml)。两组间失血量、MAP及AST变化无明显差别。 DCS组较CS组有较高的体温、中心静脉压和小时尿量、较低的心率以及较轻的酸中毒和凝血障碍。DCS组外周血心肌酶CK的升高、各脏器中性粒细胞浸润(MPO)程度、NF-κB活性、TNF-α水平以及病理损伤亦较CS组更低。尽管生存分析两组间无显著性差别(p=0.160)，24h损伤控制手术组较传统手术组有较小的死亡率(20% vs 50%)。 结论：损伤控制组较传统手术能缩短手术时间、减少输液量、更快的纠正“酸中毒、凝血障碍、低体温”、避免进一步加重休克复苏后的再灌注损伤和炎症反应、维护多脏器功能，从而提高早期生存率。 第三部分 损伤控制处理后行确定性手术时间的研究 目的：比较损伤控制手术(破损肠管快速夹闭、临时关腹)处理后不同时间对凝血、酸中毒、全身感染情况、各脏器炎症反应及肠粘膜屏障功能的影响。进而探讨行确定性手术的合理时间。 方法：雌性本地杂种猪，麻醉后建立多发肠管损伤合并“致死三联征”的严重腹部创伤实验模型，后采用损伤控制处理(同第二部分)。接着随机分为4组：DCS 6h、DCS12h、DCS24h、DCS48h组(n=6)，分别于损伤控制性剖腹术术后6h、 12h、24h、48h后采血后处死动物取各脏器病理检查。检测指标：动脉血乳酸、血常规、凝血四项；外周血TNF-α内毒素、细菌培养；末端回肠H&E、透射电镜(TEM)病理以及对荧光异硫氰酸酯葡聚糖(FD-4)通透性；末端回肠组织TNF-α水平、NF-κB活性。 结果：动脉乳酸术后12h明显下降，与24h、48h无显著性差别。凝血参数PT、 PTT在术后12h、24h逐步趋于正常，48h再次延长。术后白细胞、中性粒细胞、淋巴细胞计数逐步升高，24h达最高，48h反而下降，出现白细胞、粒细胞缺失、淋巴细胞减少、中性粒细胞比例低下。外周血内毒素、细菌培养阳性率随时间逐步升高，而TNF-α水平以12h为最低、48h最高。动物在各个时间点处死后大体观察提示肠管夹闭后逐步出现近端肠管的扩张，在48h甚至出现闭合肠袢的缺血和颜色灰暗。H&E及TEM病理检查均提示末端回肠损伤程度以12h最轻，48h最重。末端回肠组织NF-κB活性随时间逐渐增高，而TNF-α浓度以及对FD-4通透性亦以12h为最低，48h最高。 结论：动物一般状况、血乳酸、凝血异常在术后12h基本逐步恢复；24h后逐步出现肠屏障功能障碍、内毒素血症、过度炎症反应、免疫抑制以及凝血障碍。此模型下肠管夹闭后二次确定性手术应该在24h之前完成，最佳时间在12h，避免延误至48h。 第四部分 损伤控制处理对小肠吻合口愈合及长期生存率的影响 目的：比较损伤控制手术(破损肠管快速夹闭、临时关腹)处理后不同时间后行确定性肠吻合与传统一期肠吻合相比对小肠吻合口愈合及长期死亡率的影响。进一步验证确定性手术时间的选择。 方法：雌性本地杂种猪，麻醉后建立多发肠管损伤合并“致死三联征”的严重腹部创伤实验模型(同第一部分)。院内阶段均采用气管插管后呼吸机辅助呼吸、复温；回输自体血及适量晶体完全复苏。同时行剖腹探查，肠系膜缝扎止血、切除或修补损伤肠管，接着随机分为5组(n=10)：传统手术组(CS)、DCS6h、 DCS 12h、DCS 24h、DCS 48h组，相应的行一期手术或于损伤控制手术术后6h、 12h、24h、48h后开腹行二次确定性肠吻合。术后每日采血，第10天处死取肠吻合。检测指标：血常规、外周血TNF-α、CK、AST。测定在体吻合口破裂压、吻合口周组织羟脯氨酸含量，统计吻合口愈合率；行吻合口H&E、Masson染色病理检查以及扫描电镜检查。另外观察创伤后10d生存率。 结果：外周血TNF-α以DCS 12h组为最低，DCS 48h组为最高，其余组无显著性差别。除DCS 48h组外，WBC术后轻度下降，但仍维持在较高的水平；DCS48组术后3d白细胞水平仍低下，术后5天明显升高并高于其他组；而以DCS 12h组术后5天后WBC最低。CK和AST术后3d基本恢复正常，各组间无明显差别。活体内吻合口破裂压、吻合口羟脯氨酸含量、吻合口愈合率以DCS 12h组最高，DCS48h组最低。吻合口病理H&E染色提示DCS 12h组愈合最好，DCS 48h组最差。Masson染色见吻合口周围有大量的胶原纤维波浪样排列，没有特定的方向性，无胶原结节形成。阳性染色光密度分析提示DCS12h组较其他组有更多的胶原纤维形成，而以DCS48h组胶原纤维形成最少。吻合口扫描电镜提示吻合口表面大量蛋白聚糖大分子及胶原纤维聚集，以DCS 12h组纤维聚集最多，蛋白聚糖大分子最少；DCS 48h组纤维聚集最少，表面亦有大量脓苔的聚集。尽管生存分析提示仅DCS12h、DCS24h两组与DCS48h组间有显著差别(40%，40% vs 80%) (p＜0.05)，其余组间无明显差别，DCS12h和DCS24h组较CS、 DCS 6h组亦有较小的死亡率(40%，40% vs 60%，60%)。 结论：实验表明12h、24h后行再次肠吻合确定性手术较其他组降低术后炎症反应，有助于提高10d生存率；48h后行再次肠吻合确定性手术加剧了术后炎症反应，降低了 10d生存率。12h后行肠吻合确定性手术能有效的提高小肠吻合的愈合率、愈合程度；6h和24h后行肠吻合确定性手术较传统手术组不能有效地提高小肠吻合的愈合率、愈合程度；48h后行肠吻合确定性手术，肠吻合的愈合情况较对照组反而更差。因此，此模型下损伤控制处理后二次确定性肠吻合手术应该在24h之前完成，最佳时间在12h，避免延误至48h。 关键词：损伤控制性外科；致死三联征；腹部创伤；肠管夹闭；小肠吻合；伤口愈合；临时关腹；确定性手术；肠粘膜屏障；免疫抑制；感染

 The traditional concept that the first time for the treatment of any surgical diseases is the best time for the definitive repair or rebuilding of the organic injuries, but the post-operative remarkable fatality rate gradually led to the recognition that the death cause is not the failure of the operation, but the following post-operative physiological environmental dysfunction and disorders, which eventually led to the triple of low body temperature, coagulopathy and acidosis, as is also known as the "lethal triad". Because of the severe surgical emergency case in trauma, damage control surgery (DCS) came into being. It changes the concept of doing definitive repair at the first time, and it more emphasizes on life saving and best reversing pathophysiological changes in severe trauma patients. The fundamental objective of staged laparotomy is to accomplish definitive operative management in a calculated, stepwise fashion based on the patient's physiologic tolerance. It includes simple and fast surgery (damage control laparotomy, DCL), post-operative recovery in intensive care unit and the next definitive operation. Meanwhile DCL includes three phases: Ⅰ, rapid control of bleeding, such as temporary vascular shunt, abdominal packing, etc.; Ⅱ, rapid control of the leakage of the perforated abdominal hollow organs, such as ligation or occluder closure of the injuried intestines, etc.; Ⅲ, temporary closure of abdominal cavity. It is rapid and simple, can avoid the greater damage caused by primary repair, and is in favor of anti-shock, recovery and evacuation. It can make the definitive surgery more effective and successful. Although the main task of DCL is to control bleeding quickly, and rapid control of intra-abdominal pollution is not the main step of DCS, but it's essential. The previous clinical retrospective study largely focused on packing in intra-abdominal hemorrhage and temporary abdominal open in abdominal compartment syndrome (ACS), and rarely on the rapid ligation to control pollution of hollow organs. And almost no research was related to animal experiments, and the practice of DCS is mainly dependent on personal experiences. No suitable experimental model is a major impact on the evolution of DCS. In this study, we, first of all, established a ‘lethal triad' model of serious abdominal trauma induced multiple intestinal injuries to study the cffect of rapid control of multiple bowel perforations compared with traditional abdominal surgery and to explore the best time for the definitive operation after DCL. PARTⅠ Establishment of a model of multiple intestinal injuries with "lethal triad" caused by severe abdominal trauma Objective: Most of previous trauma models involving controlled and uncontrolled hemorrhage and combined with soft tissue injury or bone system injury, failed to meet the "lethal triad" and there is no intra-abdominal contamination, peritonitis, or sepsis. To fit the research of damage control surgery in severe abdominal trauma, this experiment aimed at establishing a model of multi-intestinal injuries with "lethal triad". The experimental model of severe abdominal trauma was expected to be used in the experimental study of the next step. Methods: Six female domestic outbred pigs were anesthetized and instrumented with the carotid artery and vein catheters for hemodynamic monitoring and infusion use. After gastrostomy, cystostomy following small abdominal incision, the lateral abdomen was shot 20cm from the pubic symphysis, and 10㎝ from the ventral midline. Immediately after the shooting, 50% total blood volume (35ml/㎏) hemorrhage from the carotid artery in 20 min was performed. After a 40-min shock period, 4h of pre-hospital phase was mimicked by normal saline (NS) resuscitation to maintain systolic blood pressure (SBP)＞ 80mmHg or mean arterial pressure (MAP)＞ 60mmHg. When SBP＞ 80mmHg or MAP＞ 60mmHg, no fluid infusion or additional bleeding was given. At the end of pre-hospital phase, the model of severe abdominal trauma with "lethal triad" was completed. Then the hospital phase (blood transfusion, tracheal intubation, rewarming, and etc), and different surgical intervention (DCS or traditional surgery, and etc.) can be simulated. Hemodynamic parameters were recorded and arterial blood gases, coagulation parameters and blood routine were examined. Myocardium, lung, small intestine and liver pathological examination were also involved. Results: After the shooting injury, there were multiple intestinal perforations (8-10 site injuries and similar in each animal) leading to intra-abdominal contamination, mesenteric injury (1-2 site injuries and similar in each animal) resulting in partial intestinal ischemia and intra-abdominal hemorrhage (＜150ml) and no large colon and the mesenteric vascular injury. Before completing the model establishment (at the end of prehospital resuscitation), an animal has died and the mortality rate was 16.7%. The vital signs of remaining animals was still stable, but all spontaneously became low body temperature (33.3±0.5℃). Hemodynamics after traumatic hemorrhage showed the typical shock characteristics. All animals had shown low body temperature, acidosis, and coagulopathy after pre-hospital resuscitation. Pathological examination showed that myocardium, lung, small intestine and liver were severely injuried. Conclusion: The model successfully simulated three stages of "traumatic hemorrhagic shock, pre-hospital recovery and hospital phase" and induced the "lethal triad" accompanied with abdominal pollution. It had most clinical relevance. This model has good stability and high reproducibility. The survival animals can be used for next experimental intervention (damage control laparotomy or early definitive operation, etc.). PART Ⅱ The effect of damage control surgery on early mortality in serious abdominal trauma compared with traditional surgery Objective: To compare the effects of damage control surgery and the traditional surgery following serious abdominal trauma on hemodynamics, coagulation, acidosis, systemic inflammatory response, organic injuries and early mortality. Methods: Female domestic outbred pigs, after the model establishment of multiple bowel injury associated with "lethal triad" in serious abdominal trauma (same with the first part), were then randomly divided into two groups: conventional surgery (CS) and damage control surgery (DCS) groups (n = 6/per group). Hospital phase included endo-tracheal intubation and mechanically ventilation, rewarming, and appropriate autologous blood and lluid transfusion. At the same time, laparotomy, hemostasis of mesenteric bleeding and bowel resection or repair were performed, the CS group underwent end-to-end intestinal anastomoses, peritoneal lavage and abdominal closure; DCS group underwent intestinal ligation by silk, peritoneal lavage, temporary abdominal closure. The operation time, all blood loss, volume of fluid infusion and hemodynamic parameters were recorded. Arterial blood gases, coagulation parameters, myocardial enzyme CK, liver enzyme AST were also examined. 6h later, the survival were sacrificed. TNF-α levels and NF-κB activities of myocardium, lung, small intestine and liver, as well as conventional H&E staining and myeloperoxidase (MPO) immunohistochemical staining pathological examinations were also observed. Other 2 groups (n = 10) were used to assesse survival at 24 h. Result: The DCS group had a shorter operation time than the CS group (1.1 ± 0.2h vs 2.4 ± 0.3h), and less infusion (3204±254ml vs 3756±313ml). There was no significant difference in blood loss, MAP and AST between the two groups. DCS group had higher CVP and urine volume, lower heart rate, and less acidosis and coagulopathy. Serum CK elevation and organic TNF-α levels, NF-κB activities, neutrophil infiltration and pathological injuries were also lower in the DCS group than that of CS group. Although the survival analysis had no significant difference (p= 0.160), the mortality rate at 24h in DCS group was lower than that of CS group (20% vs 50%). Conclusion: Damage control surgery, compared with traditional surgery, could shorten operation time, reduce fluid infusion, speed up to correct "metabolic acidosis, coagulopathy, low body temperature", avoid increasing further reperfusion injuries and systemic inflammatory response, prevent MODS and improve survival. PART Ⅲ Choose a best time for the definitive operation after damage control laparotomy Objective: To study the coagulation, acidosis, systemic infection, organic inflammatory response and intestinal mucosal barrier at different time after the damage control laparotomy. Further to choose a best time for the definitive operation after DCL. Methods: Female domestic outbred pigs, after the model establishment of multiple bowel injury associated with "lethal triad" in serious abdominal trauma, were treated with DCL (same with the second part). Then all animals randomly divided into 4 groups: DCS 6h, DCS 12h, DCS 24h, DCS 48h group (n - 6), and the animals were sacrificed 6h, 12h, 24h, 48h after DCL respectively. Arterial blood lactate, coagulation, TNF-α and endotoxin levels and bacterial culture of peripheral blood, and terminal ileum pathology, transmission electron microscope (TEM) examination and permeability to fluorescein isothiocyanate-dextran (FD-4) were determined. Terminal ileum TNF-α level and NF-κB activity were also included. Results: Arterial lactate decreased significantly in group DCS 12h compared with group DCS 6h, but no significant difference was found compared with group DCS 24h and group DCS 48h. Coagulation parameters of PT, PTT gradually become shorter at 12h and 24h, however they extended again at 48h. Postoperative WBC, neutrophil, lymphocyte count increased gradually and peaked at 24h. However, at 48h, we found absence of leukocyte and granulocyte cell, lymphocyte reduction and low proportion of neutrophil. Serum endotoxin level and positive rate of bacterial culture increased gradually over time. However, serum TNF-α level was lowest at 12h but highest at 48h. Animals were sacrificed at various time points for the general observation of the ligated intestine. It showed that the proximal intestine gradually expanded after intestine ligation, and at 48h the closed intestinal loops even appeared obvious ischemia and dark colors. The light microscope and TEM pathology of terminal ileum showed the lightest injuries at 12h and the severest injuries at 48h. Ileal mucosal permeability to FD-4 and TNF-α concentration were also lowest at 12h and highest at 48h. However, NF-κB activity of ileum gradually increased over time. Conclusion: The general condition of animals, blood lactate, and coagulation were gradually improved at the 12h. 24h later, the intestinal barrier dysfunction, endotoxemia, excessive inflammation, immune suppression, as well as coagulation disorder gradually appeared. In this model, the definitive operation after intestinal ligation should be carried out before the 24h, best at 12h. We should avoid any delay to 48h. PART Ⅳ The effect of damage control surgery on intestinal anastomotic healing and long-term survival Objective: To study the effects of DCS (rapid intestinal lagation, undergoing re-operation at different times) on intestinal anastomoses and long-term mortality compared with the traditional surgery (doing definitive intestinal anastomoses at the first operation). Further to validate the choice of re-operative time after DCL. Methods: Female domestic outbred pigs, after the model establishment of multiple bowel injury associated with "lethal triad" in serious abdominal trauma (same with the first part), were then randomly divided into five groups (n = 10): conventional surgery (CS), DCS 6h, DCS 12h, DCS 24h, DCS 48h groups. Hospital phase in all groups included endo-tracheal intubation and mechanically ventilation, rewarming, and appropriate autologous blood and fluid transfusion. Laparotomy, hemostasis of mesenteric bleeding and bowel resection or repair was also performed. Then the CS group underwent end-to-end intestinal anastomoses, peritoneal lavage and abdominal closure; DCS group underwent intestinal ligation by silk, peritoneal lavage, temporary abdominal closure and definitive intestinal anastomoses 6h, 12h, 24h, 48h later, respectively. Venous blood was collected daily until the intestinal anastomoses were resected on post-operative day (POD) 10. Serum TNF-α, WBC, CK and AST were examined. Anastomotic breakdown pressure (ABP), hydroxyproline (HP) content, and anastomotic H&E and Masson staining and scanning electron microscope (SEM) pathological changes were determinated. Survival at lOd was also assessed. Results: Serum TNF-α was lowest in DCS 12h group, and highest in DCS 48h group, and there was no significant difference between other groups. Except DCS 48h group, WBC decreased after operation, but still remained relatively high; WBC in group DCS 48 is still low on POD3, but increased significantly on POD5 and higher than other groups. However, group DCS12 had the lowest WBC after POD5. Enzymes CK and AST returned to normal after POD3, no significant difference was found between groups. ABP in vivo, anastomotic HP content, the rate of anastomotic healing were highest in DCS I2h group, and lowest in DCS 48h group. HE staining anastomotic pathology showed DCS 12h group had the best healing, DCS 48h group had the worst healing. Masson staining anastomotic pathology showed a large number of collagen libers which were wave-like arranged around the anastomoses, with no specific direction and no nodule formation. Positive staining optical density analysis showed that DCS 12h Group had more collagen fibers than other groups, and DCS 48h group had the lowest formation of collagen fibers. SEM showed that a large quantity of proteoglycans and collagen fibers in anastomotic surface. Group DCS 12h had the most fibers, and the least proteoglycans. However, in the DCS 48h group, a paucity of collagen fibers could be noticed, with the largest quantity of proteoglycans. Although survival analysis showed significant differences were found only between DCS 12h, DCS 24h groups and DCS 48h group (40%, 40% vs 80%) (p＜0.05), and no significant difference between other groups, DCS 12h and DCS 24h group had the lower mortality rate than that of CS and DCS 6h Groups (40%, 40% vs 60%, 60%). Conclusion: The experiment showed that the DCS 12h and DCS 24h groups had a lower postoperative inflammatory response and a higher survival rate than other groups. However, DCS 48h group had the worst inflammatory response and survival. DCS 12h group had the best anastomosis healing and DCS 48h group had the worsest anastomosis healing. DCS 6h and DCS 24h groups couldn't improve anastomosis healing. Therefore, in this model of intestinal injuries, definitive operation should be performed prior to 24h after DCL, and best at 12h. We should avoid any delay to 48h. Key words: damage control surgery; death triad; abdominal trauma; intestinal ligation; intestinal anastomosis; wound healing; temporary abdominal closure; definitive operation; intestinal barrier dysfunction; immunosuppression; infection