腹主动脉和下腔静脉枪伤的处理:俄乌战争中一名受伤战斗员的病例报告。

IF 2 Q2 EMERGENCY MEDICINE
Igor Lurin, Eduard Khoroshun, Vitalii Makarov, Volodymyr Negoduiko, Serhii Shypilov, Yurii Bunin, Maksym Gorobeiko, Andrii Dinets
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引用次数: 0

摘要

背景:俄乌战争导致严重创伤,包括大血管损伤。穿透性主动脉损伤仍然是最难处理的损伤之一;枪伤的死亡率为 90%-100%,由于出血无法控制,经常出现致命后果。在腹部三条主要静脉中,下腔静脉(IVC)是最常受损的静脉,因此需要快速做出适当的手术决定。人们对主动脉和下腔静脉等主要血管枪伤的处理知之甚少。值得一提的是,分享我们在战争中的实践经验对于战争外科医生更好地理解和考虑未来的血管创伤处理非常重要。本研究的目的是展示腹部枪弹碎片盲穿伤的诊断和处理的具体特点,以及主动脉分叉水平和下腔静脉肾下段的损伤:一名 44 岁的乌克兰武装部队男性士兵在迫击炮爆炸中腹部中弹受伤。根据 "黄金一小时 "原则,患者在受伤后一小时内被后送至前方外科小组(角色 1)并接受了初级外科治疗。然后,病人被转送到哈尔科夫的角色 3 医院。在第 3 号角色医院,患者接受了二诊手术和损伤控制手术。在复查时,没有观察到活动性出血,手术垫(先前由前方外科小组包装)已被移除。进一步的复查显示,主动脉分叉处的主动脉壁内有一个金属弹丸,下腔静脉壁也有缺损。使用多功能外科磁性工具取出了金属弹丸,随后缝合了主动脉壁缺损和下腔静脉缺损:应用损伤控制手术是处理严重血管损伤的有效方法,也是阻止肠内容物污染腹腔的有效方法。应用外科磁性工具搜索和清除铁磁性异物可减少手术创伤,缩短识别异物的时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of gunshot injury to the abdominal aorta and inferior vena cava: a case report of a combat patient wounded in the Russo-Ukrainian war.

Background: Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90-100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava.

Case presentation: A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars' explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the "golden hour" principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava.

Conclusions: Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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