腹部穿透伤致大血管损伤18例的治疗

The diagnosis and management of penetrating abdominal injury with large vessels damage in 18 cases

目的总结腹部穿透伤致大血管损伤的诊治经验。方法回顾性分析天津医科大学第二医院2003年1月至2014年10收治的18例腹部穿透伤致大血管损伤患者的临床资料、诊治过程。结果本组累及18例大血管损伤，占同期穿透伤16．21％（18／111），及时行剖腹探查术：动脉损伤8例，动静脉同时损伤4例，静脉损伤6例，动、静脉破损行侧壁修补和成型术，脾动静脉破裂1例行血管结扎后并脾切除术，合并其他脏器损伤行相应毁损脏器修补和切除，本组未行血管移植，血管修复成功率100％。术中出血量500～6000ml，平均（3750±670）ml，手术时间2．5～7．0h，平均（3．9±0．8）h，平均住院日（10±4）d，全部临床治愈，无一例围手术期死亡。术后随访12例，6例失访，采用门诊复查及电话随访，随访时间2～36个月，平均随访时间（15±7）个月，随访采用彩超结合物理检查，结果显示修复血管血流通畅，未发生血栓形成、血管闭塞、假性动脉瘤及动静脉瘘等并发症。结论腹部穿透伤致大血管损伤及时救治，应用限制性液体复苏抗休克，早期手术，快速控制出血是最有效的治疗方法。

Objective To investigate the experience of diagnosis and treatment of abdominal penetrating injury with large vessels damage. Methods The clinical data of 18 patients with abdominal large vessels injuries in our hospital from Jan 2003 to oct 2014 were analyzed retrospectively. Results 18 cases of large vessels injuries, accounting for 16. 21% during the same period of all penetrating wounds （18/111）, emergency laparotomy was performed. There were 8 cases of arterial injury, 4 cases of concurrent arteriovenous injury, 6 cases of venous injury, Arterial and venous broken walls were repaired, splenic artery and venous ligation and splenectomy were performed. Vascular repair success rate was 100% , Intraoperative blood loss was 500 - 6 000 ml, average （3 750 ± 670） ml. Operating time varied from 2.5 to 7 h,average （3.9±0. 8） h. All patients were cured. 12 cases were followed-up for 2 -36 months, mean follow-up time was （15 ± 7） months, uhrasonography showed normal blood flow without complications. Conclusions Emergency surgical exploration and limited fluid resuscitation is the most effective therapy in abdominal penetrating injury involving large vessels.