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目的探讨胸廓上口大血管损伤病因分类和救治经验。方法分析经手术治疗的64例胸廓上口大血管损伤的临床资料,其中男44例,女20例;年龄18~68岁。致伤原因分别为创伤性(锐器伤、钝性或减速伤)、病理性及医源性损伤。损伤部位归为颈根部和胸顶部两类,损伤血管为颈总动脉、无名动脉、锁骨下动脉及伴行的静脉。手术方式(1)按损伤原因及部位的分类选择切口;(2)依血管具体损伤选用不同修复方法(或体外循环下)。结果治愈56例(88%),死亡7例(11%),致残1例(2%)。结论对颈根部血管损伤宜间断压迫止血并扩创施术;胸顶部血管损伤需开胸控制血管近端后施术,特殊病例需在体外循环支持下实施血管分流和重建。
Objective To investigate the etiological classification and treatment of upper thoracic vascular injury. Methods The clinical data of 64 cases with thoracic supracervical vascular injury were analyzed. There were 44 males and 20 females, aged 18-68 years old. The causes of trauma were traumatic (sharp injury, blunt or deceleration injury), pathological and iatrogenic injury. Injury sites are classified as the genital neck and the top of the chest two categories, vascular injury for the common carotid artery, the unnamed artery, subclavian artery and accompanying vein. Surgical methods (1) according to the causes of injury and site selection incision; (2) according to the specific damage to the blood vessels using different repair methods (or under cardiopulmonary bypass). Results 56 cases were cured (88%), 7 died (11%) and 1 disabled (2%). Conclusions The blood vessels in the root of the neck should be punctured intermittently to stop the bleeding and expand the wound. The thoracic aortic blood vessels should be controlled by the thoracotomy and the blood vessels should be treated proximally. In special cases, the blood vessels need to be shunted and reconstructed with cardiopulmonary bypass.