中国普外基础与临床杂志

中国普外基础与临床杂志

介入技术在动脉创伤损伤控制性手术中的应用

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目的 探讨介入技术在动脉创伤患者损伤控制性手术中的应用及效果。 方法 回顾性分析 2011 年 3 月至 2018 年 6 月期间于解放军第 960 医院接受损伤控制性手术治疗的 31 例动脉创伤患者的临床资料。所有患者均先行介入治疗动脉损伤,待生命体征稳定行进一步“确定性手术”治疗。 结果 31 例患者的介入手术成功率为 100%;手术时间 43~100 min、(57±6)min;术中出血量 50~200 ml、(80±54)mL。31 例中采用覆膜支架治疗 11 例,采用多层裸支架重叠治疗 9 例,采用弹簧圈栓塞治疗 11 例。介入治疗后所有患者的动脉出血得到控制,患者休克症状立即得到改善。本组无围手术期死亡和介入手术相关并发症病例。二期外科手术后所有患者均顺利出院。本组患者均获访,随访时间 6~24 个月、(17±5)个月。2 例覆膜支架置入的患者发生支架腔内不同程度内膜增生,但再狭窄率<50%,无需二期处理;其余患者损伤动脉血流保持通畅,损伤动脉未再出血。随访期间 9 例多层裸支架重叠技术治疗的患者的侧支血管均通畅。所有患者在随访期间未发现支架移位、扭曲、断裂、内漏等并发症。在随访期间内确定性手术后患者恢复较好,所有患者的骨折愈合良好,致残率为 0。 结论 对于动脉创伤合并其他创伤的救治,依据“损伤控制性外科”理念,应用介入技术安全有效。

Objective To investigate the effect of vascular interventional technique in arterial injuries of damage control surgery. Methods A retrospective review was made on clinical data of 31 arterial injuries cases who received damage control surgery from March 2011 to June 2018. All cases underwent endovascular therapy for arterial injuries in No. 960 Hospital of Chinese People’s Liberation Army, and then the definitive operation was operated as soon as the vital signs became stable. Results The surgery was successful in all patients, and the operation time was 43–100 min [(57±6) min], the intraoperative blood loss was 50–200 mL [(80±54) mL]. Bleeding was successful controlled in 11 cases with covered stents, 9 cases with multiple overlapping bare stents, and 11 cases with spring coil, all cases with shock were improved immediately. There were no perioperative mortality or procedure-related complication occurred. All cases were discharged from hospital smoothly after two-phase surgery. All the patients were followed up for 6 to 24 months [(17±5) months]. Two patients with covered stent lumen stenosis less than 50% as showed by angiography, and no secondary treatment was required. In addition, blood flow patency was kept in the rest of artery, no bleeding occurred in injured artery. During the follow-up period, the collateral vessels of 9 patients treated with multi-layer bare stent overlapping technique were unobstructed. Stent migration, fracture or leakage was not found during the follow-up period. Patients recovered well after definitive surgery, they had good fracture healing with a disability rate of 0. Conclusion Rational application of vascular interventional technique in damage control surgery is a safe and effective treatment method for arterial injuries combined with other traumas.

关键词: 动脉创伤; 介入手术; 损伤控制; 临床应用

Key words: arterial injury; endovascular therapy; damage control; clinical application

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