医源性腹部大血管损伤预防与处理  

The prevention and management of iatrogenic major abdominal vascular injury.

作　　者：杨文奇[1] 孟翔凌[1] 彭程[1] 金小干[1] 朱化刚[1] 李永翔[1] 江积瑞[1] 

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《中国实用外科杂志》2001年第7期432-434,共3页Chinese Journal of Practical Surgery

摘　　要：目的　探讨医源性腹部大血管损伤发生的原因、预防措施及处理方法。方法　回顾性总结分析 1985～ 1999年间共发生的 2 0例医源性腹部大血管损伤的临床资料。结果　医源性腹部大血管损伤大多发生于肿瘤病人 ,多数是静脉损伤 ;损伤的血管包括腹主动脉、下腔静脉、门静脉、肠系膜上静脉、髂外静脉、髂内静脉、肾静脉 ,其中单处裂伤 11例 ,多处裂伤 1例 ,撕裂伤 6例 ,横断伤 1例 ,节断性离断 1例。血管修复方法包括缝合修补、端端吻合、自体静脉移植、自体腹膜补片、缝合结扎等。术中及术后死亡 7例。结论　医源性腹部大血管损伤重在预防 ,及时并合适地修复损伤血管是决定病人预后的关键。Objective To investigate the common causes of iatrogenic major abdominal vascular injuries and to clarify its possible prevention and management measures.Methods A retrospective study of 20 patients with iatrogenic major abdominal vascular injuries from 1985 to 1999 was performed.Results Most injuries(n=18)involved the vein system and were associated with radical operations of cancers in which the tumor was adjacent to the vessel;the injuries involved abdominal aorta(n=2)、inferior vena cava(n=6)、portal vein(n=3)、superior mesenteric vein(n=3)、external iliac vein(n=2)、internal iliac vein(n=3)、renal vein(n=1)and consisted of single rupture(n=11)、multiple rupture(n=1)、blunt tear(n=6)、transection(n=1)and segmental transection(n=1);the repair techniques included suture a blood vessel、end-to-end anastomosis、autologous vein grafting、autologous peritoneal patch and ligation;the overall mortality of the series was 35%.Conclusion Prevention is still the best treatment for iatrogenic major abdominal vascular injury and timely and adequate repair of the involving vessel is the key to survial and good outcome.

关 键 词：医源性血管损伤 腹部 预防 处理 

分 类 号：R654.3[医药卫生—外科学] R619.5[医药卫生—临床医学]