Prichayudh Supparerk, Rassamee Pattanapong, Sriussadaporn Suvit, Pak-Art Rattaplee, Sriussadaporn Sukanya, Kritayakirana Kritaya, Samorn Pasurachate, Narueponjirakul Natawat, Uthaipaisanwong Apinan
Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
Chulalongkorn University, Surgery, Rama4 rd, Bangkok, Thailand.
Injury. 2019 Jan;50(1):137-141. doi: 10.1016/j.injury.2018.11.045. Epub 2018 Nov 26.
Abdominal vascular injuries (AVIs) remain a great challenge since they are associated with significant mortality. Penetrating injury is the most common cause of AVIs; however, some AVI series had more blunt injuries. There is little information regarding differences between penetrating and blunt AVIs. The objective of the present study was to identify the differences between these two mechanisms in civilian AVI patients in terms of patient's characteristics, injury details, and outcomes.
From January 2007 to January 2016, we retrospectively collected the data of AVI patients at King Chulalongkorn Memorial hospital, including demographic data, details of injury, the operative managements, and outcomes in terms of morbidity and mortality. The comparison of the data between blunt and penetrating AVI patients was performed.
There were 55 AVI patients (28 blunt and 27 penetrating). Majority (78%) of the patients in both groups were in shock on arrival. Blunt AVI patients had significantly higher injury severity score (mean(SD) ISS, 36(20) vs. 25(9), p = 0.019) and more internal iliac artery injuries (8 vs. 1, p = 0.028). On the other hand, penetrating AVI patients had more aortic injuries (5 vs. 0, p = 0.046), and inferior vena cava injuries (7 vs. 0, p = 0.009). Damage control surgery (DCS) was performed in 45 patients (82%), 25 in blunt and 20 in penetrating. The overall mortality rate was 40% (50% in blunt vs. 30% in penetrating, p = 0.205).
Blunt AVI patients had higher ISS and more internal iliac artery injuries, while penetrating AVI patients had more aortic injuries and vena cava injuries. Majority of AVI patients in both groups presented with shock and required DCS.
腹部血管损伤（AVI）仍然是一个巨大的挑战，因为它们与显著的死亡率相关。穿透性损伤是AVI最常见的原因；然而，一些AVI病例系列中钝性损伤更多。关于穿透性和钝性AVI之间差异的信息很少。本研究的目的是在患者特征、损伤细节和结局方面，确定平民AVI患者中这两种机制之间的差异。
从2007年1月至2016年1月，我们回顾性收集了朱拉隆功国王纪念医院AVI患者的数据，包括人口统计学数据、损伤细节、手术管理以及发病率和死亡率方面的结局。对钝性和穿透性AVI患者的数据进行了比较。
共有55例AVI患者（28例钝性损伤和27例穿透性损伤）。两组中大多数患者（78%）入院时处于休克状态。钝性AVI患者的损伤严重程度评分显著更高（平均（标准差）ISS，36（20）对25（9），p = 0.019），且髂内动脉损伤更多（8例对1例，p = 0.028）。另一方面，穿透性AVI患者的主动脉损伤更多（5例对0例，p = 0.046），以及下腔静脉损伤更多（7例对0例，p = 0.009）。45例患者（82%）接受了损伤控制手术（DCS），钝性损伤患者25例，穿透性损伤患者20例。总体死亡率为40%（钝性损伤患者为50%，穿透性损伤患者为30%，p = 0.205）。
钝性AVI患者的ISS更高，髂内动脉损伤更多，而穿透性AVI患者的主动脉损伤和腔静脉损伤更多。两组中大多数AVI患者均表现为休克，需要进行损伤控制手术。
