医源性门静脉和肠系膜上静脉损伤的紧急处理  

Emergency management of iatrogenic injury of portal vein and superior mesenteric vein

作　　者：高志清[1] 付由池[1] 刘正才[1] 

机构地区：[1]第四军医大学西京医院肝胆外科,西安710032

出　　处：《中华肝胆外科杂志》2009年第9期645-646,共2页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨医源性门静脉和肠系膜上静脉损伤的紧急处理和预防。方法回顾性分析医源性门静脉和肠系膜上静脉损伤的致伤原因及术中治疗经过，并就预防进行了探讨。结果该组7例，其中门静脉损伤2例，肠系膜上静脉损伤5例。5例采用pringle手法暂时压迫止血后，用5-0血管缝线缝合修补破口，出血控制；2例因操作粗暴，胡乱钳夹，最终死亡。结论预防上述血管损伤及预先游离周围组织至关重要，一旦损伤，应冷静沉着，暂时压迫止血后，用血管缝线缝合修补破口，止血效果好，是确实有效的方法。禁止胡乱钳夹止血。Objective To explore the emergency management and prevention of iatrogenic injury of inferior vena cava. Methods A retrospective study was undertaken to investigate the operative procedure and post-operative outcome of 7 patients suffering from iatrogenic injury of inferior vena cava in the course of three nephrectomy, one right adrenal gland tumor resection, one right surgical kidney, one right upper retroperitoneal tumor and one pancreaticoduodenectomy. The gross hemorrhage was controlled by local pressure. Then, abdominal incision was done. Firm pressure on the inferior vena cava was performed to right side for temporary control of hemorrhage. The bleeding part could be found when the hematocele was cleaned. And continuous suture should be done with 3-0 silk or absorbable suture after the crevasse was clamped. Results In these 7 cases, 1 died of hemorrhagic shock and the other 6 had significant effect postoperatively. The associated injuries were healed well except 1 case of slight edema of lower extremity. Conclusion Iatrogenic injury of inferior vena cava can be treated successfully with correct procedure. Furthermore, the injury could be avoided with exactitude intraoperative procedure.

关 键 词：创伤和损伤 门静脉损伤 肠系膜上静脉损伤 手术 处理 

分 类 号：R686[医药卫生—骨科学]