摘要
目的研究四种方法治疗围术期骨盆损伤伴血管损伤的临床效果。方法回顾性分析2018年10月—2021年9月陆军军医大学大坪医院战创伤医学科围术期骨盆损伤伴血管损伤大出血患者22例,男性13例,女性9例;年龄23~61岁,平均41.8岁。术前行骨盆CT检查21例。创伤致血管破裂17例,医源性血管损伤5例。髂外动脉2例,髂外静脉1例,髂内动脉主干2例,髂内动脉及多分支5例,股静脉3例,臀上动脉4例,阴部内动脉、闭孔动脉和骶前静脉丛损伤各1例,未明确损伤血管名称2例。软组织伴血管损伤4例,取骨盆内固定致血管损伤1例,髋臼骨折3例,骨盆骨折8例,骨盆和髋臼双重骨折6例。其中采用选择性动脉栓塞治疗6例;髂内动脉结扎术5例;腹膜外骨盆填塞术3例,其中腹膜外骨盆填塞后结合介入治疗1例;血管吻合术8例,其中髂外静脉吻合术后介入下行髂内动脉分支选择性动脉栓塞治疗1例。结果骨盆CT发现骨盆损伤导致血管损伤17例,敏感率100%。失血性休克死亡1例,病死率4.5%,为腹膜外填塞患者,占3例腹膜外填塞33.3%。术中请血管外科医师缝扎骶前静脉丛及吻合髂外静脉各1例,术后出现骨盆术区感染、坏死3例(13.6%);术后深静脉血栓形成2例(9.1%)。术区感染、坏死经清创、负压引流术等处理后愈合,深静脉血栓安置下腔静脉滤网、抗凝对症处理后,血栓消失。结论针对骨盆损伤伴血管损伤大出血选择性动脉栓塞术、髂内动脉结扎术、腹膜外填塞术、血管吻合术均为有效止血方案,根据伤情选择合适手术方式至关重要;骨盆损伤伴有休克病史患者术前做增强CT,最好CT动脉血管成像、CT静脉血管成像同时检查;术中发现大血管损伤及时处理,必要时请求专科支援。
Objective To evaluate the clinical effects of four methods to handle perioperative pelvic trauma combined with vascular injuries.Methods A total of 22 cases with pelvic trauma combined with vascular injuries and massive hemorrhage at perioperative period in the Army Medical University,Daping Hospital from Oct.2018 to Sep.2021 were retrospectively analyzed.There were 13 males and 9 females aged 23-61 years,41.8 years on average.Pelvic CT scan was performed on 21 patients before surgery.For all the 22 vascular injuries,17 were caused by trauma and the other 5 were of iatrogenic.Two cases involved the external iliac artery,1 the external iliac vein,2 the main internal iliac artery,5 the internal iliac artery and multiple branches,3 the femoral vein,4 the superior gluteal artery,1 the internal pudendal artery,1 the obturator artery,1 the presacral venous plexus,and 2 unknown.Four cases of vascular injuries were combined with soft tissue injuries,1 case was due to removal of the internal fixation plate,3 cases had acetabular fractures,8 had pelvic fractures,and 6 had both pelvic and acetabular joint fractures.For all the vascular injuries,6 were treated by interventional vascular embolization,5 by internal iliac artery ligation,3 by gauze packing,and 8 by vessel anastomosis.Results Pelvic CT scan revealed 17 cases of vascular injuries caused by pelvic trauma,with a sensitivity of 100%.One patient with gauze packing died of hemorrhagic shock,with a mortality rate of 4.5%.Suture and ligation of the presacral venous plexus and external iliac vein anastomosis were conducted by vascular surgeons,each in 1 case.Postoperative infection and necrosis occurred in 3 cases(13.6%),which achieved union after debridement and negative pressure drainage.Deep venous thrombosis occurred in 2 cases(9.1%)and healed after inferior vena cava filter placement and anticoagulation.Conclusion Interventional vascular embolization,internal iliac artery ligation,extraperitoneal tamponade,and vascular anastomosis are all effective for pelvic injuri
作者
韩玉卓
李阳
郭庆山
Han Yuzhuo;Li Yang;Guo Qingshan(State Key Laboratory of Trauma,Burns and Combined Injury,Wound Trauma Medical Center,Daping Hospital,Army Medical University,Chongqing 400042,China)
出处
《创伤外科杂志》
2023年第1期22-27,共6页
Journal of Traumatic Surgery
关键词
骨盆损伤
血管损伤
围术期
Pelvic trauma
Vascular injuries
Perioperative period
