腹部大血管破裂的诊治经验

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1、Figuresfor:InjuriestotheGreatVesselsoftheAbdomen[ACSSurgery. 2005; ©2005 WebMDInc.Allrightsreserved.]Figure1.Algorithmillustratesmanagementofintra-abdominalhematomafoundatoperationafterpenetratingtrauma.Figure2.Algorithmillustratesmanagementofintra-abdominalhematomafoundatoperationafterblunttr

2、auma.Figure3.Leftmedialvisceralrotationisperformedbymeansofsharpandbluntdissectionwithelevationoftheleftcolon,theleftkidney,thespleen,thetailofthepancreas,andthegastricfundus.Figure4.Shownisanautopsyviewofthesupraceliacaortaandtheceliacaxis,theproximalsuperiormesentericartery,andthemediallyrot

3、atedleftrenalarteryafterremovaloflymphaticandnervetissue.Figure5.Anaorticcompressiondeviceisusedtocontrolhemorrhagefromthevisceralportionoftheabdominalaorta.Figure6.A22-year-oldmanwithagunshotwoundtotherightupperquadranthadinjuriestotheprepyloricareaofthestomachandtothesupraceliacabdominalaort

4、a.Theaorticinjurywasmanagedbymeansofsegmentalresectionandreplacementwitha16mmpolytetrafluoroethylene(PTFE)graft.Thepatientwenthome46daysafterinjury.Figure7.An18-year-oldmanexperiencedagunshotwoundtotheheadofthepancreasandtheproximalsuperiormesentericartery.AWhippleprocedurewasperformed,anda6mm

5、PTFEgraftwasplacedintheartery.Theartery-graftsuturelinedehiscedsecondarytoapancreaticleakonday30afterinjury,andthepatientdiedonday42.Figure8.(a)Whencomplexgraftingprocedurestothesuperiormesentericarteryarenecessary,itmaybedangeroustoplacetheproximalsuturelinenearanassociatedpancreaticinjury.(b

6、)Theproximalsuturelineshouldbeontheloweraorta,awayfromtheupperabdominalinjuries,andshouldbecoveredwithretroperitonealtissue.Figure9.Shownisagunshotwoundtotheinfrarenalabdominalaortaviewedthroughstandardinframesocolicexposure.Patient'sheadisatthebottomofthephotograph.Figure10.ShownisPTFEpatchre

7、pairofaninjurytotheinfrarenalinferiorvenacava.Figure11.Arightperirenalhematomawasnotopenedatoperation,becausepreoperativeabdominalCTdocumentedareasonablyintactkidney.Figure12.Midlineloopingofrespectiverenalvesselsisperformedbeforeentryi