CAJ | 학술논문

目的总结腹部穿透伤致大血管损伤的诊治经验. 方法回顾性分析天津医科大学第二医院2003年1月至2014年10收治的18例腹部穿透伤致大血管损伤患者的临床资料、诊治过程.结果本组累及18例大血管损伤,占同期穿透伤16.21％ (18/111),及时行剖腹探查术;动脉损伤8例,动静脉同时损伤4例,静脉损伤6例,动、静脉破损行侧壁修补和成型术,脾动静脉破裂1例行血管结扎后并脾切除术,合并其他脏器损伤行相应毁损脏器修补和切除,本组未行血管移植,血管修复成功率100％.术中出血量500 ～6000 ml,平均(3 750±670) ml,手术时间2.5 ～7.0h,平均(3.9±0.8)h,平均住院日(10±4)d,全部临床治愈,无一例围手术期死亡.术后随访12例,6例失访,采用门诊复查及电话随访,随访时间2 ～36个月,平均随访时间(15 ±7)个月,随访采用彩超结合物理检查,结果显示修复血管血流通畅,未发生血栓形成、血管闭塞、假性动脉瘤及动静脉瘘等并发症. 结论腹部穿透伤致大血管损伤及时救治,应用限制性液体复苏抗休克,早期手术,快速控制出血是最有效的治疗方法.
목적 총결복부천투상치대혈관손상적진치경험. 방법 회고성분석천진의과대학제이의원2003년1월지2014년10수치적18례복부천투상치대혈관손상환자적림상자료、진치과정.결과 본조루급18례대혈관손상,점동기천투상16.21％ (18/111),급시행부복탐사술;동맥손상8례,동정맥동시손상4례,정맥손상6례,동、정맥파손행측벽수보화성형술,비동정맥파렬1례행혈관결찰후병비절제술,합병기타장기손상행상응훼손장기수보화절제,본조미행혈관이식,혈관수복성공솔100％.술중출혈량500 ～6000 ml,평균(3 750±670) ml,수술시간2.5 ～7.0h,평균(3.9±0.8)h,평균주원일(10±4)d,전부림상치유,무일례위수술기사망.술후수방12례,6례실방,채용문진복사급전화수방,수방시간2 ～36개월,평균수방시간(15 ±7)개월,수방채용채초결합물리검사,결과현시수복혈관혈류통창,미발생혈전형성、혈관폐새、가성동맥류급동정맥루등병발증. 결론 복부천투상치대혈관손상급시구치,응용한제성액체복소항휴극,조기수술,쾌속공제출혈시최유효적치료방법.
Objective To investigate the experience of diagnosis and treatment of abdominal penetrating injury with large vessels damage.Methods The clinical data of 18 patients with abdominal large vessels injuries in our hospital from Jan 2003 to oct 2014 were analyzed retrospectively.Results 18 cases of large vessels injuries,accounting for 16.21％ during the same period of all penetrating wounds (18/111),emergency laparotomy was performed.There were 8 cases of arterial injury,4 cases of concurrent arteriovenous injury,6 cases of venous injury,Arterial and venous broken walls were repaired,splenic artery and venous ligation and splenectomy were performed.Vascular repair success rate was 100％,Intraoperative blood loss was 500-6 000 ml,average (3 750 ±670) ml.Operating time varied from 2.5 to 7 h,average (3.9 ±0.8) h.All patients were cured.12 cases were followed-up for 2-36 months,mean follow-up time was (15 ± 7) months,ultrasonography showed normal blood flow without complications.Conclusions Emergency surgical exploration and limited fluid resuscitation is the most effective therapy in abdominal penetrating injury involving large vessels.