Baeshko A A, Klimovich V V, Voevoda M T, Orlovskiĭ Iu N, Gornostaĭ P V, Iushkevich V A
Khirurgiia (Mosk). 2006(4):12-9.
Results of treatment of 102 patients with injuries of inferior vena cava (IVC) were analyzed. The causes of injury were penetrating stab-incised wounds of abdomen (67.5% patients), close trauma (28.2%), gunshot wounds (4.3%). Zone of confluence of iliac veins was injured in 7% patients, infrarenal and renal segments -- in 51.9%, suprarenal -- in 21.5%, supra- and retrohepatic -- in 19.6% patients. Injury of one wall of vein was revealed in 63.7% patients, both walls -- in 14.7%, complete disruption of vessel -- in 7.9%, avulsion or fissure of hepatic veins -- in 13.7%. In 96.2% patients trauma of IVC were associated with injuries of liver (37.2% cases), small intestine (26.4%), stomach (15.6%), pancreas (12.7%), duodenum (10.7%), large intestine (6.8%), and other organs (10.7%). The side suture (83.7%), circular one (5%), ligation of vein (6.2%), grafting (3.8%), and ligation of left hepatic vein (1.3%) were performed. Reconstructive surgery was carried out by general surgeon in 30% patients, and by vascular surgeon -- in 70%. Lethality was 53.9% (55 patients). Lethality after injuries of supra- and retrohepatic segments of IVC was 100%, suprarenal and renal segments -- 60.6%, infrarenal segment -- 30.6%.
分析了102例下腔静脉(IVC)损伤患者的治疗结果。损伤原因包括腹部穿透性刺伤(67.5%的患者)、闭合性创伤(28.2%)、枪伤(4.3%)。7%的患者髂静脉汇合区受损,肾下段和肾段受损的占51.9%,肾上腺段受损的占21.5%,肝上段和肝后段受损的占19.6%。63.7%的患者静脉壁一侧受损,两侧壁受损的占14.7%,血管完全断裂的占7.9%,肝静脉撕脱或破裂的占13.7%。96.2%的患者IVC损伤合并肝脏损伤(37.2%的病例)、小肠损伤(26.4%)、胃损伤(15.6%)、胰腺损伤(12.7%)、十二指肠损伤(10.7%)、大肠损伤(6.8%)以及其他器官损伤(10.7%)。采用侧方缝合(83.7%)、环形缝合(5%)、静脉结扎(6.2%)、移植(3.8%)以及左肝静脉结扎(1.3%)等方法进行治疗。30%的患者由普通外科医生进行重建手术,70%由血管外科医生进行。死亡率为53.9%(55例患者)。IVC肝上段和肝后段损伤后的死亡率为100%,肾上腺段和肾段损伤后的死亡率为60.6%,肾下段损伤后的死亡率为30.6%。