Meagher D P, Defore W W, Mattox K L, Harberg F J
J Trauma. 1979 Jul;19(7):532-6.
A 20-year retrospective evaluation of vascular trauma in infants and children was undertaken. The study included 53 cases of blunt and penetrating vascular injuries in pediatric patients. There were 36 males and 17 females ranging in age from 24 days to 14 years (average, 10 years). The most frequently encountered sites of arterial trauma were the brachial or superficial femoral artery, and of venous trauma the inferior vena cava. Any patient presenting to the Emergency Center with an injury in proximity to a major vessel, hematoma formation, audible bruit, or palpable thrill underwent prompt arteriography or immediate operative exploration of the injury sit. All patients in the series were managed operatively. There were 41 major arterial and 32 major venous injuries. No patient required a major amputation. Most injuries were repaired by primary closure or segmental resection and end-to-end anastomosis; interposition vein grafts and substitute conduits were used in four patients with more extensive injuries. A 13% operative mortality was encountered: the most frequent cause of death was intraoperative exsanguinating hemorrhage. The triad for successful management of vascular trauma in pediatric patients is: 1) a high index of suspicion, 2) performance of aggressive diagnostic studies when indicated, and 3) prompt surgical intervention.
对婴儿和儿童血管创伤进行了一项为期20年的回顾性评估。该研究包括53例儿科患者的钝性和穿透性血管损伤。其中男性36例，女性17例，年龄从24天至14岁（平均10岁）。动脉创伤最常发生的部位是肱动脉或股浅动脉，静脉创伤最常发生的部位是下腔静脉。任何因靠近大血管处受伤、形成血肿、可闻及杂音或可触及震颤而就诊于急诊中心的患者，均需迅速进行动脉造影或立即对损伤部位进行手术探查。该系列中的所有患者均接受了手术治疗。有41例主要动脉损伤和32例主要静脉损伤。没有患者需要进行大截肢。大多数损伤通过一期缝合或节段性切除及端端吻合进行修复；4例损伤较广泛的患者使用了静脉移植和替代导管。手术死亡率为13%：最常见的死亡原因是术中大出血。成功处理儿科患者血管创伤的三要素是：1）高度怀疑，2）在有指征时进行积极的诊断性检查，3）迅速进行手术干预。
