自发性髂静脉破裂:病例报告兼文献复习

Spontaneous rupture of the iliac vein:case report and review of literatures

目的:分析自发性髂静脉破裂的诊断与外科治疗。方法:报告本院2003年收治的1例左髂外静脉自发性破裂病例,并检索国内外相关文献,取其中资料完整的24篇文献,共26例病人(包括本例病人),对其临床表现、影像学检查、病理学检查、手术方式和预后进行分析。结果:女24例,男2例。突发下腹部疼痛或饱胀(25/26)、下肢肿胀(8/26)为主要症状,24例存在休克。发生于左侧髂静脉(24/26),仅2例发生于右侧髂外静脉。影像学检查显示为髂窝混合性肿块。22例接受破裂静脉壁修补,4例行髂静脉结扎。8例病理学检查无明显异常。21例存活,5例死亡。结论:突发下腹部肿块或疼痛、休克且无外伤史的女性病人,为该病的诊断要点。积极复苏、及时剖腹探查和破裂静脉壁修补可取得较好预后。

Objective To study the diagnosis and surgical management of spontaneous rupture of iliac vein. Methods One ease of spontaneous rupture of left exterual iliac vein treated at our hospital in 2003 was reported. Related Chinese and English literatures were reviewed regarding clinical manifestations, radiological and pathological findings, surgical procedures and outcomes. Twenty-six cases including our case with complete data from 24 papers were combined and analyzed. Results Twenty-four cases were females and 2 males. The clinical features were characterized by sudden onset of lower abdominal pain or distention in 25 cases, leg swelling in 8 cases and shock in 24 cases. In 24 cases, rapture occurred in the left iliac vein and in 2 cases in the right external iliac vein. Radiological examination showed one large mass of heterogeneous density in iliac fossa. Repair of ruptured veins was performed in 22 cases and ligation procedure in 4 cases. No definitive pathological finding was confirmed in 8 cases. Five cases died and the other 21 survived. Conclusions The diagnosis of spontaneous rupture of the iliac vein should be considered in non-traumatic female patients with sudden onset of lower abdominal pain or mass and concomitant shock. Prompt resuscitation, emergency laparotomy and repair of the ruptured vein might give good results in an otherwise fatal condition.