NEJM:手部创伤性血管损伤-病例报道

2020-08-20 MedSci原创 MedSci原创

这种血管异常可能是由先天性、感染后或外伤性原因引起的。如果切开不当,则存在大量出血的风险。

患者为一名10岁的男孩,因左手掌上有一个不断增长的疼痛性病灶而到急诊就诊。三天前,他的手被菜刀割伤。最初受伤后,伤口已在急诊室缝合。本次就诊时,最初怀疑为伤口脓肿,并在预期切口和引流的情况下将聚维酮碘涂抹手部。

手术前检查手部发现手指神经血管完整,且有一个较大的搏动性肿块,无温热或红斑(如图A所示)。病灶部位听诊有杂音。

这种血管异常可能是由先天性、感染后或外伤性原因引起的。如果切开不当,则存在大量出血的风险。

该患者动脉瘤被游离并切除(如图B所示),患者康复,无并发症。

原始出处:

Paige E. Stevens,et al.Traumatic Vascular Injury to the Hand.N Engl J Med 2020;https://www.nejm.org/doi/full/10.1056/NEJMicm2000950

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    2020-12-15 amyloid
  2. [GetPortalCommentsPageByObjectIdResponse(id=2025513, encodeId=1a6820255139e, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Tue Dec 15 15:36:03 CST 2020, time=2020-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1705714, encodeId=8a3b1e0571469, content=<a href='/topic/show?id=8e408966501' target=_blank style='color:#2F92EE;'>#血管损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89665, encryptionId=8e408966501, topicName=血管损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84ba31025715, createdName=bbwuyu_013, createdTime=Thu Nov 12 06:36:03 CST 2020, time=2020-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885225, encodeId=d5928852254f, content=这个应该是血管瘤吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ba35398878, createdName=ms2000000913842307, createdTime=Mon Sep 14 18:14:08 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335314, encodeId=fa1d1335314b6, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1398038, encodeId=e842139803863, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035384, encodeId=e80b10353847c, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Aug 20 11:36:03 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811269, encodeId=fe0a81126926, content=噢, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=626e1296645, createdName=573722703, createdTime=Thu Aug 20 08:43:36 CST 2020, time=2020-08-20, status=1, ipAttribution=)]
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    2020-09-14 ms2000000913842307

    这个应该是血管瘤吧

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=2025513, encodeId=1a6820255139e, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Tue Dec 15 15:36:03 CST 2020, time=2020-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1705714, encodeId=8a3b1e0571469, content=<a href='/topic/show?id=8e408966501' target=_blank style='color:#2F92EE;'>#血管损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89665, encryptionId=8e408966501, topicName=血管损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84ba31025715, createdName=bbwuyu_013, createdTime=Thu Nov 12 06:36:03 CST 2020, time=2020-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885225, encodeId=d5928852254f, content=这个应该是血管瘤吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ba35398878, createdName=ms2000000913842307, createdTime=Mon Sep 14 18:14:08 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335314, encodeId=fa1d1335314b6, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1398038, encodeId=e842139803863, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035384, encodeId=e80b10353847c, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Aug 20 11:36:03 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811269, encodeId=fe0a81126926, content=噢, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=626e1296645, createdName=573722703, createdTime=Thu Aug 20 08:43:36 CST 2020, time=2020-08-20, status=1, ipAttribution=)]
    2020-08-20 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2025513, encodeId=1a6820255139e, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Tue Dec 15 15:36:03 CST 2020, time=2020-12-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1705714, encodeId=8a3b1e0571469, content=<a href='/topic/show?id=8e408966501' target=_blank style='color:#2F92EE;'>#血管损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89665, encryptionId=8e408966501, topicName=血管损伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=84ba31025715, createdName=bbwuyu_013, createdTime=Thu Nov 12 06:36:03 CST 2020, time=2020-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=885225, encodeId=d5928852254f, content=这个应该是血管瘤吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ba35398878, createdName=ms2000000913842307, createdTime=Mon Sep 14 18:14:08 CST 2020, time=2020-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335314, encodeId=fa1d1335314b6, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1398038, encodeId=e842139803863, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Fri Aug 21 23:36:03 CST 2020, time=2020-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035384, encodeId=e80b10353847c, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Aug 20 11:36:03 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811269, encodeId=fe0a81126926, content=噢, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=626e1296645, createdName=573722703, createdTime=Thu Aug 20 08:43:36 CST 2020, time=2020-08-20, status=1, ipAttribution=)]
    2020-08-20 573722703

    0

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