右胸腹刀刺伤伴胸内动脉损伤:胸腹刀刺伤1例报告及经验教训

Vasyl Pronin, Mariia Matvieienko
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摘要

摘要胸腹和跨纵隔损伤是外科医生面临的最具挑战性的损伤。的目标。目的:介绍一种罕见的胸腹损伤右胸内动脉损伤的临床诊断和治疗。材料和方法。我们报告一例罕见的胸腹损伤右胸内动脉损伤的临床病例,并伴有大量血胸、休克和DIC综合征。结果。这项工作提出了检查和治疗的数据病人胸腹刺伤。初步诊断:右侧胸腹部刺伤,失血性休克。诊断是根据患者的主诉、病史、体格检查资料、检查时可获得的资料、实验室结果和仪器研究方法确定的。术中确定了肝脏、膈肌和胸内动脉的损伤。临床关注的不仅是这种损伤的罕见性-胸内动脉损伤,而且是治疗和诊断策略。结论。我们认为这个案例很有趣,也很有教育意义。每个伤口都应该从可能损伤大血管的角度来评估,在哪个位置的投影是局部的。伤口的初步手术治疗应在经验丰富的外科医生的严格控制下进行,特别是如果伤口位于大血管的突出处。必须确认血管的完整性和没有出血!术中,任何发现都应考虑在内,与可能的损伤相关联,并进行临床解释(提供符合临床情况的逻辑解释)。关于治疗策略的决定应由外科医生(或外科医生委员会)立即根据临床情况作出。外科医生必须反应灵活,并有能力根据发现迅速改变入路。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Right thoracoabdominal stab injury penetrating with injury of the internal thoracic artery: case report and lessons in penetrating knife wounds to the chest and abdomen
Abstract. Thoraco-abdominal and transmediastinal injuries are the most challenging injuries faced by surgeons. Aim. To acquaint medical practitioners with a clinical case of diagnosis and treatment of a rare variant of damage to the right internal thoracic artery in a thoraco-abdominal injury. Materials and methods. We present a clinical case of a rare variant of damage to the right internal thoracic artery in a thoraco-abdominal injury, which was complicated by a massive hemothorax, shock and DIC syndrome. Results. The work presents data on the examination and treatment of a patient with a thoraco-abdominal stab wound. A preliminary diagnosis was established: thoraco-abdominal stab wound on the right, hemorrhagic shock. The diagnosis was established based on the patient's complaints, medical history, physical examination data, available at the time of the examination, the results of laboratory and instrumental research methods. Damage to the liver, diaphragm, and internal thoracic artery was established intraoperatively. Clinical interest is not only the rarity of this injury - injury of the internal thoracic artery, but also the therapeutic and diagnostic tactics. Conclusions. We consider this case interesting and instructive. Each wound should be evaluated from the point of view of possible injury of large vessels, in the projection of which location it is localized. The primary surgical treatment of the wound should be carried out under the strict control of an experienced surgeon, especially if the wound is located in the projection of a large vessel. The integrity of the vessel and the absence of bleeding must be confirmed! Intraoperatively, any finding should be taken into account, correlated with possible injuries, and interpreted clinically (provide a logical explanation that satisfies the clinical situation). The decision regarding treatment tactics should be made by the operating surgeon (or a board of surgeons), immediately based on the clinical situation. The surgeon must be reactive and flexible, and have the ability to quickly change the approach according to the findings.
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