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周围血管损伤的外科治疗

创伤性四肢血管损伤修复经验及教训

报道58例创伤性四肢主要血管损伤的修复。介绍了受伤原因、血管损伤部位、类型、并发症、处理方法。讨论了诊断及漏诊原因，修复原则及错误，分析了3例肢体坏死原因，认为尽早重建血管的连续性是恢复肢体血运的关键。

ARTIFICIAL VASCULAR PROSTHESIS IN THE REPAIR OF ARTERIAL INJURIES OF THE EXTREMITIES

From June, 1987 through June, 1994, 126 cases of injuries of major arteries of the extremities were treated, in which Nationedmade Teflon artificial vascular prosthesis was used to repair in 20 cases. Eighteen of the twenty cases were operated immediately after initial injury and the other two had secondary operation. The sites of the original injuries were as follows: the external iliac artery in 1, femoral artery in 15, popliteal artery in 2 and the brachial artery in 2. The length of the defect of the artery was measured from 3 to 12cm. In 2 of 20 cases, the artificial vascular prosthesis was used because of the failurs of primary repair from autogenous saphaneous vein graft. The shortterm patency rate was 100 per cent and the longterm patency rate was 95 per cent. The diagnosis of vascular injury, the properties of the artificial vascular prosthesis and the points important in operation were discussed.

四肢主要血管火器伤的修复重建

对40 例四肢主要血管火器伤患者的临床资料进行回顾性分析，总结损伤的有效救治方法。 方 法 1986 年5 月－ 2006 年11 月，收治40 例四肢主要血管火器伤患者。男35 例，女5 例；年龄16 ～ 50 岁，平均31. 2 岁。动脉完全断裂16 例，动脉部分断裂6 例，动脉缺损14 例，动脉血栓形成2 例，假性动脉瘤2 例。病程12 min ～ 20 h。彻底清创、充分减压和引流，根据不同情况选择自体静脉移植25 例，人造血管移植3 例，血管吻合6 例，血管修补4 例，带血管蒂的轴型皮瓣游离移植2 例。 结果 经抗感染、输血补液及抗凝、扩张血管等治疗，死亡1 例，截肢2 例，肾衰竭截肢1 例，成功修复36 例。伤口Ⅰ期愈合29 例，Ⅱ期愈合7 例。经7 个月～ 2 年随访，修复血管均恢复通血，肢端血运良好，动脉搏动正常，按英国医学会感觉运动功能评定标准：优28 例，良6 例，差2 例。 结论 “生命第一、肢体第二”是四肢主要血管火器伤的救治原则，采用自体静脉或人造血管旁路移植修复可获良好效果。

APPLICATION OF CROTCH-SHAPED VEIN GRAFTS IN REPAIRING DEFECTS OF THEVESSELS WITH A LARGE DIAMETER

Objective To investigate the results and applicationvalue of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter.Methods From June 1998 to October 2003, 35 cases of vesseldefects with a large diameter were repaired with crotch-shaped vein graft (29 males and 6 females,aged 18 to 45 years with an average of 25.7 years ). The locations of defects were femoral artery in 25 cases, popliteal artery in 2 cases, femoral vein in 7 cases, and subclavian vein in 1 case. The interval between injure and operatioinwas 1-8.5 hours (4.1 hours on average).The blood flows of trouble and healthy vascular were determined with Doppler detector and compared preoperatively andpostoperatively. Results All the anastomotic stomas were patent in 35 cases. Thirty-one cases were followed up 6 weeks to 24 months (9.5 months on average), the patent rate was 100%, no case occurred vasospasm or tromboembolism; 2 cases occurred stomal leak and became hematoma, 3 cases occurred muscular necrosis, and the 5 cases achieved primary healing after secondary operation. The Doppler results showed that there was statistically significant difference in the blood flow betweenpostoperation and preoperation (Plt;0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular (Pgt;0.05). Conclusion The methodof crotch-shaped vein grafts is safe and effective in repairing defects of vessels with a large diameter,which is easy to draw materials and handy to operate. It has a promising value in clinical application.

ADVANCES IN THE DIAGNOSIS AND TREATMENT OF ACUTE VASCULAR INJURIES

肢体大中血管损伤诊治经验

报道43例肢体大中血管损伤,治愈29例,功能欠佳4例,截肢6例,死亡4例。强调在急救中,以保存生命为前提。对腘部伤要动态观察。脉搏存在不能除外血管损伤,主张并发大静脉伤应修复。血管吻合后要妥善固定。

REPAIR OF DEFECTS AT BOTH ENDS OF BLOOD VESSELS IN EXTREMITIES WITH AGREAT DISPARITY IN DIAMETER BY VEIN TRANSPLANTATION

Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.

腹部大血管损伤13例诊治体会

创伤性浮膝合并血管损伤的治疗

目的 总结创伤性浮膝合并血管损伤的手术方法及疗效。 方法 2001 年3 月－ 2008 年3 月收治23 例创伤性浮膝合并血管损伤。男14 例，女9 例；年龄21 ～ 63 岁。车祸伤15 例，高处坠落伤5 例，重物砸伤3 例。开放骨折16 例，按照Gustilo 分型：Ⅰ型8 例，Ⅱ型6 例，Ⅲ型2 例。血管损伤类型：横行断裂12 例，纵行裂伤4 例，挫伤缺损4 例，内膜损伤栓塞3 例。受伤至入院时间为30 min ～ 4 h，平均2 h。采用小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管。 结果 骨折均获解剖复位。术后外固定针道感染3 例。4 例于术后7 ～ 10 d 出现切口浅表感染，其余切口均Ⅰ期愈合。1 例于术后12 d 因缺血坏死、感染行截肢术，余22 例保全肢体。22 例术后获随访，随访时间14 ～ 38 个月，平均18.5 个月。骨折均愈合，愈合时间为15 ～ 24 周。术后1 年肢体功能按Karlstrouml;m 等评价标准，优10 例，良8 例，中3 例，差1 例。 结论 小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管，是治疗创伤性浮膝合并血管损伤的一种较好选择。