University of Arizona College of Medicine, Tucson, Arizona.
University of Arizona College of Medicine, Tucson, Arizona.
J Surg Res. 2019 Oct;242:94-99. doi: 10.1016/j.jss.2019.04.043. Epub 2019 May 6.
Traumatic superior mesenteric vein (SMV) injury is rare, and the ideal treatment is controversial. We compared the outcomes of ligation versus repair of SMV injury using the National Trauma Databank.
All adult patients who suffered from traumatic SMV injury were identified from the National Trauma Databank (2002-2014) by International Classification of Diseases (ICD) codes. Patients were stratified by treatment modality into no repair, ligation, and surgical repair using ICD procedure codes. Patient characteristics were compared between ligation and surgical repair groups using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. Outcomes, including mortality, rates of small bowel resection, length of stay (LOS), and ventilation days were compared using logistic regression.
Among 952 patients with SMV injury, 192 patients (20.2%) had ligation, 428 (50%) underwent surgical repair, and 332 patients (34.9%) had neither repair nor ligation of the SMV. Overall hospital mortality was 32%. Age, gender, injury severity score (ISS), and Glasgow Coma Scale (GCS) were similar between groups that underwent ligation and surgical repair. Although the mortality rate (29.4% versus 36.5%, P = 0.20) and bowel resection rate (4% versus 3%, P = 0.12) were similar, patients who underwent repair had significantly longer hospital LOS (19.4 ± 24.8 versus15.2 ± 24.4 d, P < 0.001) and ICU LOS (13 ± 17.1 versus 9.3 ± 11.8 d, P = 0.02) compared to ligation. Similar results were observed in multivariable analysis when adjusted for race, associated vascular injuries, and other associated injuries.
In patients with traumatic SMV injury, surgical repair does not appear to confer a significant survival advantage over ligation and can be associated with greater LOS and ICU LOS. Ligation may be an acceptable option for management of a traumatic SMV injury, especially when surgical repair cannot be performed, without compromising patient mortality or bowel resection rates.
创伤性肠系膜上静脉（SMV）损伤较为罕见，其理想的治疗方法存在争议。我们利用国家创伤数据库比较了结扎与修复 SMV 损伤的效果。
利用国际疾病分类（ICD）编码从国家创伤数据库（2002-2014 年）中筛选出所有创伤性 SMV 损伤的成年患者。根据 ICD 手术编码，将患者分为未修复、结扎和手术修复组。采用 Kruskal-Wallis 检验比较连续变量，采用 Fisher 确切概率法比较分类变量，比较结扎与手术修复组之间的患者特征。采用 logistic 回归比较死亡率、小肠切除术率、住院时间（LOS）和通气天数等结局。
952 例 SMV 损伤患者中，192 例（20.2%）接受了结扎，428 例（50%）接受了手术修复，332 例（34.9%）既未修复也未结扎 SMV。总体住院死亡率为 32%。行结扎和手术修复的两组患者年龄、性别、损伤严重程度评分（ISS）和格拉斯哥昏迷评分（GCS）相似。尽管死亡率（29.4%与 36.5%，P=0.20）和肠切除术率（4%与 3%，P=0.12）相似，但修复组患者的 LOS（19.4±24.8 与 15.2±24.4 d，P<0.001）和 ICU LOS（13±17.1 与 9.3±11.8 d，P=0.02）明显更长。在多变量分析中，当调整种族、相关血管损伤和其他相关损伤时，也观察到了类似的结果。
在创伤性 SMV 损伤患者中，手术修复似乎并不能比结扎明显提高生存率，反而可能会导致 LOS 和 ICU LOS 延长。当无法进行手术修复时，结扎可能是一种治疗创伤性 SMV 损伤的可接受方法，且不会影响患者死亡率或肠切除术率。
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