Accola K D, Feliciano D V, Mattox K L, Bitondo C G, Burch J M, Beall A C, Jordan G L
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
Am J Surg. 1987 Dec;154(6):613-8. doi: 10.1016/0002-9610(87)90227-3.
During a 12 year period, 79 patients with a diagnosis of a penetrating wound to the suprarenal aorta were treated. An analysis of the records of these patients has led to the following conclusions: With a midline penetrating wound and presence of a supramesocolic hematoma or hemorrhage, injury to the suprarenal aorta should be suspected. If a midline supramesocolic hematoma is present or if hemorrhage can be controlled by direct pressure, a lateral approach with medial mobilization of the intraabdominal viscera on the left side allows rapid vascular control. Although lateral aortorrhaphy is preferred, patch grafting, and end-to-end anastomosis, or insertion of a prosthetic graft was required in 46 percent of the patients who underwent repair. As in all previous series, the insertion of synthetic patches or prostheses was not complicated by infection. The average survival rate for injuries to the suprarenal aorta in series reported since 1974 is 33 percent. Finally, the continuing problem of irreversible shock suggests the need for rapid transport from the field to the hospital for victims of penetrating wounds to the abdomen.
在12年期间，对79例诊断为肾上腺主动脉穿透伤的患者进行了治疗。对这些患者的记录分析得出以下结论：对于中线穿透伤且存在结肠上区血肿或出血的情况，应怀疑肾上腺主动脉损伤。如果存在中线结肠上区血肿，或者出血可通过直接压迫控制，采用左侧经外侧入路并向内侧游离腹内脏器可实现快速的血管控制。尽管优先选择外侧主动脉修补术，但在接受修复的患者中，46%的患者需要进行补片移植、端端吻合或置入人工血管。与之前所有系列研究一样，置入合成补片或人工血管并未出现感染并发症。自1974年以来报告的系列研究中，肾上腺主动脉损伤的平均生存率为33%。最后，不可逆休克这一持续存在的问题表明，腹部穿透伤受害者需要从现场迅速转运至医院。
