摘要
目的 探讨胸廓上口大血管损伤病因分类和救治经验。方法 分析经手术治疗的64例胸廓上口大血管损伤的临床资料，其中男44例，女20例；年龄18～68岁。致伤原因分别为创伤性（锐器伤、钝性或减速伤）、病理性及医源性损伤。损伤部位归为颈根部和胸顶部两类，损伤血管为颈总动脉、无名动脉、锁骨下动脉及伴行的静脉。手术方式：（1）按损伤原因及部位的分类选择切口；（2）依血管具体损伤选用不同修复方法（或体外循环下）。结果 治愈56例（88％），死亡7例（11％），致残1例（2％）。结论 对颈根部血管损伤宜间断压迫止血并扩创施术；胸顶部血管损伤需开胸控制血管近端后施术，特殊病例需在体外循环支持下实施血管分流和重建。
Objective To discuss etiological classification of great vessels injuries of thoracic outlet and report treatment experiences. Methods An analysis was done on 64 cases （ 44 males and 20 females, with age range of 18-68 years） of great vessels injuries of thoracic outlet treated surgically from September 1980 to December 2004. The injury causes included trauma （sharp, blunt or decelerated injuries）, pathological and iatrogenic injuries. The injured vessels included the common carotid artery, the innominate artery, the subclavian artery and the accompanying veins. Emergency suture or repair of the artery with polyester or autologous pericardial patch was performed in 38 cases, aneurysmectomy in six, resection of vessels with end-to-end anastomosis in five, Core-Tex vessel reconstruction in six, transplantation of the great saphenous vein in eight, and ligation of vessel in one. Results Of all, 56 cases （88%） were cured, seven （ 11% ） died and one （2%） disabled. Conclusions For vessel injury of neck root, intermissive compression hemostasis and urgent exploration are needed. While open thoracotomy is necessary to control the proximal portions of hemorrhage vessels for cases with vessel injury at top of thorax, and vascular shunt and reconstruction requires under support of extracorporeal circulation for special cases.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2006年第4期262-264,共3页
Chinese Journal of Trauma
关键词
血管
创伤和损伤
外科手术
胸廓上口
Blood vessels
Wounds and injuries
Surgical procedures, operative
Thoracic outlet
