Kobayashi Leslie M, Costantini Todd W, Hamel Michelle G, Dierksheide Julie E, Coimbra Raul
Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA.
Department of Surgery, Division of Trauma, Surgical Critical Care, and Burns, University of California, San Diego, California, USA.
Trauma Surg Acute Care Open. 2016 Jul 20;1(1):e000015. doi: 10.1136/tsaco-2016-000015. eCollection 2016.
Abdominal vascular trauma, primarily due to penetrating mechanisms, is uncommon. However, when it does occur, it can be quite lethal, with mortality ranging from 20% to 60%. Increased early mortality has been associated with shock, acidosis, hypothermia, coagulopathy, free intraperitoneal bleeding and advanced American Association for the Surgery of Trauma Organ Injury Scale grade. These patients often arrive at medical centers in extremis and require rapid surgical control of bleeding and aggressive resuscitation including massive transfusion protocols. The most important factor in survival is surgical control of hemorrhage and restoration of appropriate perfusion to the abdominal contents and lower extremities. These surgical approaches and the techniques of definitive vascular repair can be quite challenging, particularly to the inexperienced surgeon. This review hopes to describe the most common abdominal vascular injuries, their presentation, outcomes, and surgical techniques to control and repair such injuries.
腹部血管创伤主要由穿透性机制导致，较为少见。然而，一旦发生，其致死率颇高，死亡率在20%至60%之间。早期死亡率增加与休克、酸中毒、体温过低、凝血功能障碍、腹腔内游离出血以及美国创伤外科协会器官损伤严重程度评分高级别相关。这些患者往往在病情极其危急时被送达医疗中心，需要迅速进行手术控制出血，并积极进行复苏，包括实施大量输血方案。生存的最重要因素是手术控制出血以及恢复对腹部脏器和下肢的适当灌注。这些手术方法以及确定性血管修复技术颇具挑战性，尤其是对于经验不足的外科医生而言。本综述旨在描述最常见的腹部血管损伤、其临床表现、治疗结果以及控制和修复此类损伤的手术技术。
