下腔静脉损伤的救治经验:附12例报告

Experience of salvage treatment of patients with inferior vena cava injury:a report of 12 cases

目的探讨下腔静脉损伤的修复方法。方法对12例下腔静脉损伤患者临床资料进行回顾性分析。结果闭合性损伤9例,开放性损伤3例。入院时均伴有休克。均诊断为腹腔内脏损伤,无1例诊断为下腔静脉损伤。12例均手术治疗,直视下修复5例,大网膜填塞后肝实质大块褥式缝合2例,纱布填塞5例。术后并发症7例(58.3%):胆漏1例,隔下脓肿合并反应性右侧胸腔积液2例,创伤性肝囊肿1例,腔静脉血栓形成1例,大出血2例;死亡3例,病死率25.0%。结论腔静脉损伤病情凶险,处理困难,病死率高,改良的全肝血流阻断下行纱布填塞止血效果好,抢救成功率高,值得推广。

Objective To study a repair method for injury of inferior vena cava （IVC）. Methods The clinical data of 12cases with inferior vena cava injury were analyzed retrospectively. Results Nine cases were due to blunt trauma and 3 penetrating injury. All cases were in shock at the time of admission and were diagnosed as injury of abdominal organs, but none were diagnosed as injury of inferior vena cava. All 12 cases underwent operative treatment. Five cases were treated by suture of the rupture of IVC successfully, and 2 cases were treated by suture of liver after omental packing the ruptur of IVC, and other 5 cases were treated by gauze packing. Postoperative complications occurred in7 cases （58.3%） and 3 cases （25.0%） died. Among them, 1 case died of massive hemorrhage during operation, in 5 cases who were treated by gauze packing and 2 died. Conclusions It is difficult to deal with injury of inferior vena cava, mortality is high and gauze packing together with modified normothermic hepatic vascular exclusion gives good results and merits widespread application.