外科手术中大血管意外损伤的救治(附34例报告)

目的探讨外科手术中大血管意外损伤的救治经验。方法回顾分析34例术中大血管意外损伤的经验,研究其原因、特点、救治方法。结果34例中血管吻合5例(14.7%),自体静脉移植7例(20.6%), 人造血管移植1例(2.9%),血管修补9例(26.5%),血管结扎6例(17.7%),压迫等保守治疗4例(11.8%), 无法处理或未来得及处理术中死亡2例(5.9%)。输血800～15200ml,平均2862ml。结果本组死亡 6例(17.7%),截肢1例(2.9%),手术成功修复27例(79.4%)。结论 (1)手术中大血管意外损伤,可引起严重并发症和造成严重后果。(2)人为因素是主要原因,提高医生的警觉性及手术技巧,规范操作可有效地降低发生率。(31)损伤以单纯的动脉损伤为最多见,单纯静脉损伤次之,因此治疗以修补为主,静脉移植次之。(4)患者常常并发较严重的原发病,为避免顾此失彼,多脏器的兼顾与多科室问的协调在救治中较为重要。

Major vascular injuries during operation (34 cases report)

Objective To retrospectively study the results of 34 cases with major vascular injuries during op- eration from 1991 to 2003.Methods There were 25 male and 9 female patients in 34 cases,and the age from 6 to 73 years old(mean 37.4).This study was undertaken to report our experience with major vascular injuries during the operation in order to specify the circumstances under which they occurred,the means ofdiagnosis,the risk factors,and the means for prevention.Results There were 8 cases reconstruction by auto-vein or artificial blood vessel graft,and 5 cases by anastomosis,and 9 cases by direct suture,and 6 cases by ligation,and 4cases by presure and nonoperative measure,and 2 cases died without operation.There were 27 cases successful repair, and 6 cases died during the treatment,1 cases limb amputation.Conclusion Major vascular injuries during op- eration are rare but serious complications.Prevention of these accidents relies on the surgeon's experience and scrupulous respect of the safety roles.In the vast majority of cases,it is necessary to convert to a vascular surgeon immediately.