20例心脏大血管创伤后晚期后遗症的诊断与治疗

Diagnosis and Management of Traumatic Cardiovascular Sequelae

目的：报告心脏大血管创伤后晚期后遗症的诊断和治疗。方法：收集我科１９５４年６月～１９９５年４月治疗２０例心脏大血管损伤后遗症，其中穿入性损伤９例，闭合性损伤６例和医源性损伤５例。病变有瓣膜损伤８例，心脏异物５例，假性动脉瘤和动静脉瘘４例，右心室动脉瘤加心室间隔缺损（ＶＳＤ）、晚期心脏压塞和右下肺弹头、术后缩窄性心包炎各１例。施行手术早期取出心脏异物和心包腔引流４例。择期手术１５例，其中施行瓣膜替换术６例，瓣膜成形术２例，假性动脉瘤和动静脉瘘缝补术３例，心室间隔缺损加右心室室壁瘤缝补术、心腔内异物、血心包和缩窄性心包炎各１例。结果：１９例经手术治疗痊愈出院，１例因动脉导管结扎后假性动脉瘤，控制感染时突然瘤体破裂出血死亡。结论：早期诊断、早期或择期手术可取得良好效果。

Aim: Diagnosis and treatment to the delayed sequelae following cardiovascular injuries were assessed. Methods: From 1954 to 1995, 20 patients with cardiovascular trauma were managed surgically. Penetrating wounds were in 9 cases, nonpenetrating injuries in 6 cases and iatrogenic insults in 5 cases. The injuries consisted of traumatic valve in 8 cases, foreign bodies in 5 cases, pseudoaneurysm and arteriovenous fistalae in 4 cases, right ventricular aneurysm plus ventricular septal defect (VSD), late cardiac temponade plus right lung foreign bodies and constrictive pericarditis in 1 case, respectively .Nineteen patients underwent operative treatment, that was, evacuation of foreign bodies and drainge of pericardial cavity in 4 cases, replacement or repair of valves in 8 cases, neoplasty of pseudoaneurysm and arteriovenous fistula in 3 cases, repair of VSD and resection of venticular aneurysm in one case, and pericardiotomy in two cases. Results:Nineteen patients survived and one died because of abrupt rupture of the pseudoaneurysm after a ligation of patent arterial duct. Conclusion: It is attested that early diagnosis and timely or elective surgical intervention lead to gratifying effects in these patients.