小儿医源性血管损伤的手术治疗方法。

A surgical approach to iatrogenic vascular injuries in pediatric cases.

作者信息

Beşir Yüksel, Gökalp Orhan, Eygi Börteçin, Bahriye Lafcı Banu, Gökalp Gamze, Yılık Levent, İner Hasan, Gürbüz Ali

机构信息

Department of Cardiovascular Surgery, İzmir Katip Çelebi University Faculty of Medicine, İzmir-Turkey.

出版信息

Ulus Travma Acil Cerrahi Derg. 2017 May;23(3):217-222. doi: 10.5505/tjtes.2016.61282.

DOI:10.5505/tjtes.2016.61282

PMID:28530775

Abstract

BACKGROUND

Surgical intervention is mandatory in many children who present with vascular trauma or in complicated cases after medical interventions. In this study, surgical interventions applied after vascular injuries in children were analyzed.

METHODS

Between January 2002 and December 2012, 17 patients (aged under 18) who were admitted to the emergency room with vascular injuries were retrospectively analyzed. The data was collected through hospital records. Preoperative and postoperative data of the patients were recorded and analyzed.

RESULTS

Of the total, 11 patients were female (64.7%) and 6 patients were male (35.3%) with a range of 4-192 months. In total, 14 (82.3%) injuries were due to angiographic interventions, 1 (5.9%) was due to external trauma, 1 (5.9%) was due to preoperative trauma, and 1 (5.9%) was due to a catheterization complication in the intensive care unit. Additionally, 11 (64.7%) injuries were located in the right femoral artery, 3 (17.6%) were located in the left femoral artery, 2 (11.8%) were located in the left brachial artery, and 1 (5.9%) was located in the left external iliac vein. Also, 5 (29.4%) patients were managed under local anesthesia and 12 (70.6%) patients were managed under general anesthesia. With respect to treatment, 15 (88.2%) injuries were repaired with primary sutures, 1 (5.9%) injury was repaired with an end-to-end anastomosis, and 1 (5.9%) injury was repaired with a saphenous vein graft interposition. In addition, 16 (94.1%) patients underwent a thrombectomy prior to the repair. The total hospital stay was calculated as 2.7±1.4 days. The intensive care unit stay was calculated as 1.1±0.4 days. There was no mortality, a loss of an injured extremity, or an infection. No other complication was detected.

CONCLUSION

Iatrogenic interventional procedures seem to be responsible for the majority of pediatric vascular injuries. The results of surgical repairs in these injuries are successful and efficient.

摘要

背景

对于许多出现血管创伤的儿童或在医学干预后出现复杂情况的儿童，手术干预是必要的。在本研究中，分析了儿童血管损伤后应用的手术干预措施。

方法

回顾性分析2002年1月至2012年12月期间因血管损伤入住急诊室的17例（年龄小于18岁）患者。通过医院记录收集数据。记录并分析患者的术前和术后数据。

结果

总共11例患者为女性（64.7%），6例患者为男性（35.3%），年龄范围为4 - 192个月。总共14例（82.3%）损伤是由于血管造影干预，1例（5.9%）是由于外部创伤，1例（5.9%）是由于术前创伤，1例（5.9%）是由于重症监护病房的导管插入术并发症。此外，11例（64.7%）损伤位于右股动脉，3例（17.6%）位于左股动脉，2例（11.8%）位于左肱动脉，1例（5.9%）位于左髂外静脉。另外，5例（29.4%）患者在局部麻醉下接受治疗，12例（70.6%）患者在全身麻醉下接受治疗。关于治疗，15例（88.2%）损伤通过一期缝合修复，1例（5.9%）损伤通过端端吻合修复，1例（5.9%）损伤通过大隐静脉移植修复。此外，16例（94.1%）患者在修复前接受了血栓切除术。总住院时间计算为2.7±1.4天。重症监护病房住院时间计算为1.1±0.4天。无死亡、肢体丢失或感染情况。未检测到其他并发症。