腹部血管损伤104例分析

An Analysis of 104 Cases with abdominal vascular trauma

目的探讨腹部血管损伤的处理。方法对1987年10月～1998年9月收治的104例腹部血管伤病例进行回顾性分析总结。其中手术治疗99例，采用多种血管外科术式，包括裂伤缝合、静脉片贴补、对端吻合、自体血管移植、取栓术、断血脏器切除和血管结扎等。结果总病死率26．9％，ISS评分平均值37．8。6例主动脉伤存活率为50％；29例近肝静脉伤存活率为37．9％。结论应重视正确的扩容策略；早期诊断和迅速控制出血是成功救治的关键；低血容量时阻断下腔静脉甚少引发心搏骤停；改良的肝周填塞法对肝后静脉损伤有明显疗效。

Objecthe To review the experience of management of abdominal vascular injuries. Methods Retrospective analy sis was made based on the results of surgical treatment of 104 patients with abdominal vascular trauma from Oct, 1987 to Sept, 1998.Among these cases, laparotomy was performed on 99 cases by various therapetic modalities including suture of laceration, repair with vein patch, end to end anastomosis, autoplastic transplantation of vessel, embolectomy, resection of devascularized viscus and ligation of injured vessel. Results The overall mortality rate was 26. 9% with a mean ISS of 37. 8. In the subgroup, the survival rate of six pa tients with aorta injury was 50%, and twenty-nine patients with juxtabepatic venous injuries, the survival rate was 37. 9%. Conclusion A wise policy of expanding intravascular volume should be emphasized; Early diagnosis and expeditious control of bleeding can abso lutely decrease mortality; Cardiac arrest due to occlusion of inferior vena cava is virtually seldom seen under hypovolumic condition;Ac curate modified perihepatic packing is a well accepted technique for retrohepatic vein trauma.