Netto Fernando A C Spencer, Tien Homer, Hamilton Paul, Rizoli Sandro B, Chu Peter, Maggisano Robert, Brenneman Frederick, Tremblay Lorraine N
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Trauma. 2006 Nov;61(5):1053-7. doi: 10.1097/01.ta.0000241148.50832.87.
Blunt vena caval injury (BCI) is uncommon with only a few published reports in the literature. Recently, with high resolution computed tomography (CT) scan imaging signs of caval injury are sometimes found in hemodynamically stable patients. The purpose of this study was to assess the current course of patients with BCI.
Retrospective review of all patients with BCI treated at a Regional Trauma Center from April 1999 to May 2005. Data collected included demographics, mechanism of injury, associated injuries, diagnostic investigations, surgical findings, and outcomes.
During the 6-year study period, 10 patients presented with BCI (age 42 +/- 19 years; 70% mortality; Injury Severity Score 39 +/- 15). The spectrum of vena cava injury ranged from an intimal flap to extensive destruction. Six of the seven deaths were secondary to exsanguination and one secondary to severe brain injury. Four patients presented with refractory shock and were taken emergently to surgery (all died). Six patients responded to fluid resuscitation and underwent CT imaging (three out of six survived). Although active venous contrast extravasation was not seen in any patient, all six had indirect signs on CT suggestive of BCI. Overall, the diagnosis of BCI was confirmed at surgery in nine patients. The remaining patient had an intimal flap and contained pericaval hematoma confirmed by ultrasound, and was successfully managed nonoperatively.
The spectrum of BCI ranges from intimal flaps to extensive destruction. CT imaging may not diagnose or may underestimate the severity of BCI. Stable patients with intimal flaps and contained hematoma may be successfully managed nonoperatively.
钝性腔静脉损伤（BCI）并不常见，文献中仅有少数报道。近来，在血流动力学稳定的患者中，有时通过高分辨率计算机断层扫描（CT）可发现腔静脉损伤的影像学征象。本研究旨在评估BCI患者的当前治疗过程。
回顾性分析1999年4月至2005年5月在某地区创伤中心接受治疗的所有BCI患者。收集的数据包括人口统计学资料、损伤机制、合并损伤、诊断检查、手术发现及结果。
在6年的研究期间，10例患者出现BCI（年龄42±19岁；死亡率70%；损伤严重度评分39±15）。腔静脉损伤范围从内膜瓣到广泛破坏。7例死亡患者中有6例死于失血，1例死于严重脑损伤。4例患者出现难治性休克并紧急接受手术（均死亡）。6例患者经液体复苏后接受CT检查（6例中有3例存活）。尽管所有患者均未发现活动性静脉造影剂外渗，但6例患者的CT均有提示BCI的间接征象。总体而言，9例患者在手术中确诊为BCI。其余1例患者有内膜瓣且经超声证实有腔周血肿，经非手术治疗成功。
BCI的范围从内膜瓣到广泛破坏。CT成像可能无法诊断或低估BCI的严重程度。内膜瓣且有局限性血肿的稳定患者可通过非手术治疗成功。
