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胸廓上口大血管损伤的外科治疗 被引量:8

Surgical treatment of great vessel injuries of thoracic outlet
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摘要 目的 总结胸廓上口大血管损伤的外科治疗经验。 方法 回顾性分析经手术治疗的32例胸廓上口大血管损伤患者的临床资料 ,其中男性 2 4例 ,女性 8例 ;年龄 2~ 48岁。致伤原因为锐器伤、钝性或减速伤。损伤血管为颈总动脉、无名动脉、锁骨下动脉以及伴行的静脉。治疗方法为 :急诊缝合动脉破口 ,或加涤纶片修补 15例 ;动脉瘤切除 6例 ;受损血管切除端端吻合 5例 ;以Gore Tex重建血管 3例 ;大隐静脉移植 3例。 结果 治愈 2 4例 (75 % ) ,死亡 7例 (2 1 9% ) ,1例致残。 结论 胸廓上口大血管损伤患者 ,早期常因失血、脑缺氧或并存的多发伤致死 ;后期多演变成假性动脉瘤。手术多采用血管破口修复 ;在体外循环支持下实施假性动脉瘤切除 ,Gore Objective To summarize the experience in surgical treatment of great vessel injury of the thoracic outlet. Methods Thirty two cases (24 men and 8 women aged 2 48 years) treated by surgery were collected during the period of 1970 1998. Sharp injury, blunt injury or decelerated injury was the causes. The vessels of injury included the common carotid artery, subclavian artery and accompanying veins. Emergency suture or repair of the artery with polyester patch was performed in 15 patients, aneurysmectomy in 6, resection of vessels with end to end anastomosis in 5, Gore Tex vessel reconstruction in 2, and transplantation of the great saphenous vein in 3. Results Twenty four patients (75%) were cared and 7 (21 8%) died. Conclusions In the early period, patients with great vessel injury of the thoracic outlet died from acute bleeding, cerebral ischemia or combined multiple injuries, in the later period, however, false aneurysm devolope. The operation is appropriate to the recondition of damaged cut, the effect of evolution in false aneurysm is approving. For large damaged cut or for bigger vessel injuries, the repair with polyester patch, Gore Tex of blood vessel reconstruction or the transplantation of the great saphenous vein must be used.
出处 《中华外科杂志》 CAS CSCD 北大核心 2001年第11期850-851,共2页 Chinese Journal of Surgery
关键词 心血管外科 手术方法 大血管损伤 胸廓切开术 Cardiovescular surgical procedure Injury Thoracotomy Vessel
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