医源性血管损伤的预防和术中处理

Prevention and Management of Iatrogenic Injury of Blood Vessels during Operation

目的:总结手术中发生医源性血管损伤的处理经验。方法:10例在外科手术中损伤血管的患者,其中门静脉,下腔静脉、髂总静脉损伤各2例,股总静脉、颈总动脉、腋静脉、腘动脉损伤各1例。行血管修补术5例,行端-端吻合术1例,自体静脉移植术1例,人工血管移植1例,钳夹止血1例,血管结扎1例。结果:本组痊愈8例;死亡2例,其中下腔静脉损伤止血失败死亡1例,颈总动脉损伤结扎死亡1例。结论:医源性血管损伤重在预防,一旦发生血管损伤,迅速有效地控制出血是手术成功的关键,血管修补或吻合术疗效良好。

Objective：To review experience of prevention and management of iatrogenic injury of blood vessels happened in operation.Methods： Clinical data from 10 patients with iatrogenic injuries of blood vessels was analyzed,including injury of portal vein,inferior vena cave,common iliac vein,common femoral vein,axillary vein,common carotid artery and popliteal artery.Five patients accepted angiorrhaphy,one accepted end-to-end stomy,one recieved autogenous,one adopted artificial vasotransplantation,one suffered from haemostasis by ring clamp,one accepted ligation of blood vessel.Results：Two patients died,in which one died of uncontrollable bleeding due to injury of inferior vena cava,another one died of carotid Ligation.The patients received angiorrhaphy,anastomosis or reconstruction of blood vessels were cured.Conclusions：Preventing iatrogenic injury of blood vessels during operation is very important.In case of injury occurring,the effective manipulation to control bleeding should be done immediately.The anastomosis and reconstruction of blood vessels could be considerd.