腹部大血管破裂的诊治经验.docVIP

Figures for: Injuries to the Great Vessels of the Abdomen [ACS Surgery. ?2005;??2005?WebMD Inc.All rights reserved.] Figure 1.Algorithm illustrates management of intra-abdominal hematoma found at operation after penetrating trauma. Figure 2.Algorithm illustrates management of intra-abdominal hematoma found at operation after blunt trauma. Figure 3.Left medial visceral rotation is performed by means of sharp and blunt dissection with elevation of the left colon, the left kidney, the spleen, the tail of the pancreas, and the gastric fundus. Figure 4.Shown is an autopsy view of the supraceliac aorta and the celiac axis, the proximal superior mesenteric artery, and the medially rotated left renal artery after removal of lymphatic and nerve tissue. Figure 5.An aortic compression device is used to control hemorrhage from the visceral portion of the abdominal aorta. Figure 6.A 22-year-old man with a gunshot wound to the right upper quadrant had injuries to the prepyloric area of the stomach and to the supraceliac abdominal aorta. The aortic injury was managed by means of segmental resection and replacement with a 16 mm polytetrafluoroethylene (PTFE) graft. The patient went home 46 days after injury. Figure 7.An 18-year-old man experienced a gunshot wound to the head of the pancreas and the proximal superior mesenteric artery. A Whipple procedure was performed, and a 6 mm PTFE graft was placed in the artery. The artery-graft suture line dehisced secondary to a pancreatic leak on day 30 after injury, and the patient died on day 42. Figure 8.(a) When complex grafting procedures to the superior mesenteric artery are necessary, it may be dangerous to place the proximal suture line near an associated pancreatic injury. (b) The proximal suture line should be on the lower aorta, away from the upper abdominal injuries, and should be covered with retroperitoneal tissue. Figure 9.Shown is a gunshot wound to the infrarenal abdominal aorta viewed through standard inframesocoli