2～5指掌指关节至近侧指间关节间动脉缺损的修复

目的探讨2～5指掌指关节至近侧指间关节间动脉缺损的一种修复术式.方法以掌心动脉为供血管,将指总动脉近端向远端翻转来修复该类动脉的缺损.结论指总动脉及掌心动脉位置较恒定,变异少,孔径较大,且指总动脉位置浅,易于解剖,加上掌浅弓,有足够可利用的长度,用来修复掌指关节至近侧指间关节间动脉缺损,是一种比较实用的术式.但其前提是掌心动脉必须正常.     

2－5指掌指关节至近侧指间关节间动脉缺损的修复

目的：探讨2－5指掌指关节至近侧指间关节间动脉缺损的一种修复术式。方法：以掌心动脉为供血管,将指总动脉近端向远端翻转来修复该类 动脉的缺损。结论：指总动脉及掌心动脉位置较恒定,变异少,孔径较大,且指总动脉位置浅,易于解剖,加上掌浅弓,有足够可利用的长度,用来修复掌指关节至侧指间关节间动脉缺损,是一种比较实用的术式。但其前提是掌心动脉必须正常。     

蹠动脉和跗动脉转流重建下肢血循环研究近况

下肢动脉硬化闭塞症是老年男性的常见病,病情严重者可并发肢端坏疽而截肢致残,因此在发生紧急缺血临床表现时,必需及时作动脉搭桥转流术,重建血液循环以保全患肢。糖尿病是本症的高危因素之一,并且有其特殊动脉硬化闭塞的病理模式,即病变多广泛地累及小腿部动脉主干,而有些足部     

腘动脉下段分叉部损伤的早期修复

文章报告了9例腘动脉下段分叉部损伤的治疗结果。除1例为土枪霰弹伤外,其余均为钝性暴力所致。早期截肢2例,后期截肢1例,截肢率33.3％。存活肢体中1例明显小腿缺血性挛缩,1例轻度小腿缺血性挛缩,4例功能基本正常。腘动脉下段分叉部损伤具有血管损伤范围广,远端缺血严重,常伴有骨、关节及皮肤、肌肉、神经等组织损伤等特点。尽早手术,同时重建胫前、胫后动脉血循环,尽量修复及保护伤肢静脉,常规行小腿深筋膜切开减压,骨折、脱位同时予以修复并可靠固定是提高治疗效果的必要措施。     

应用受者脾动脉重建移植肝动脉

目的探讨应用受者脾动脉重建移植肝动脉的方法。方法回顾性分析1999年5月至2005年7月完成的328例次原位肝移植中的肝动脉重建方法。其中7例受者因肝总动脉不适宜吻合而采用脾动脉重建移植肝动脉。7例受者均为男性,平均年龄(42.5±11.3)岁。肝移植术中,于胰腺体部上缘处游离受者脾动脉干2cm,结扎其远端,利用其近心端与供肝肝总动脉对端吻合;在2.5倍手术放大镜下,以7-0Prolene缝线连续缝合方式完成动脉重建。结果术后行间断彩色多普勒超声扫描监测显示:7例受者肝动脉血液供应良好,无血栓形成,无胆系并发症发生,无脾脏梗死征象。2例肝细胞癌患者分别在术后18、21个月死于癌肿复发,5例良性肝病患者术后随访22.6个月(12~38个月),肝功能良好,1年生存率为100%。结论在肝移植受者肝总动脉不适宜重建移植肝动脉时,选择性应用受者的脾动脉是简便可行的动脉重建方式。     

小口径动脉移植修复大口径动脉缺损的观察

目的 探讨小口径动脉移植复大口径动脉缺损的可能性及效果。方法 应用二级大白鼠５０只,取长为７ｍｍ,口径为０．３～０．４ｍｍ的尾动脉移植修复口径为１．０～１．４ｍｍ的颈动脉缺损。分别于手术后３周及５,１０,１２个月观察移植物的通畅情况及病理变化。结果 术后１年移植物的通畅率为９５％（１９／２０）。内膜增生于术后３击主要存在于邻近吻合口部位的血管内膜,术后５个月移植动脉全长内膜增生严重,且比较均匀,术     

腹腔镜胆囊切除术后胆囊动脉假性动脉瘤自发破裂大出血一例

患者女 ,5 5岁。因外院腹腔镜胆囊切除术后 10d ,右上腹疼痛 4 + h入院。入院时查体 :T 36 5°C ,P 83次 /分 ,R 2 0次 /分 ,BP 112 / 75mmHg。神清 ,皮肤巩膜无黄染。腹平 ,中上腹及右上腹深压痛。移动性浊音阴性。肠鸣音正常。肝功能检测为 :TBIL 12 4 μmol/L ,DBIL 5 3μmol/L。B超报告 :胆囊区见 3 5cm× 1 5cm的囊性暗区 ,其内欠清晰 ,壁囊稍厚 ,欠规则 ,考虑胆囊残端膨大或胆囊积液。入院后给予补液、抗感染、保肝等对症治疗。复查肝功结果为 :TBIL196 3μmol/L ,DBIL 14 8 7μmol/L。入院后第 4天患者右上腹疼痛逐…     

暂时性体外胫后动脉旁路术的解剖学研究

目的 为暂时性体外胫后动脉旁路术提供解剖学依据.方法 对5例成人尸体10侧下肢标本的胫后动脉、胫前动脉、腓动脉及其分支进行解剖学观测.结果 本组研究未发现胫后动脉缺如,全长(291±31)mum,显露部下端外径(2.8±0.5) mm.胫后动脉在小腿内侧发出穿支皮动脉存在率100％,平均发出(4±2)支,动脉外径(1.5±0.5) mm,发自中上1/3的穿支皮动脉长度最长(6.5±3.5) cm.结论 胫后动脉及小腿内侧穿支皮动脉在小腿走行恒定,变异率小,管径粗大,易于操作,供区影响小,是暂时性体外胫后动脉旁路手术的理想选择.     

巨大冠状动脉瘤的外科治疗

目的探讨巨大冠状动脉瘤的临床特点和外科治疗要点。方法1996年7月至2004年10月,共手术治疗6例巨大冠状动脉瘤。外科治疗方法采用冠状动脉瘤切除术3例,同期冠状动脉旁路移植术2例、冠状动脉瘤成形术3例。巨大冠状动脉瘤常合并其他心血管疾病,同期行冠状动脉瘘修补手术4例,主动脉瓣置换术3例,主动脉成形术2例,冠状动脉瘤血栓清除术1例。结果所有患者均康复出院,平均体外循环时间(144±26)min(67～207min)。主动脉阻断时间(104±21)min(56～172min)。患者随访8～87个月(平均48个月)。随访中患者症状均消失,无死亡和冠状动脉瘤复发病例。结论巨大冠状动脉瘤是一种严重的心血管疾病,应及时手术治疗。     

锁骨下动脉、腋动脉、肱动脉血管广泛血栓形成1例

1病例资料患者,男,44岁。右上肢肿胀刺痛1个月加重伴手指麻木发凉5d,于2007年12月13日18：00急诊入院。患者自述于1个月前出现右侧手指指尖麻木,近5d右上肢麻木、胀痛明显加重,自测不到脉搏,右上肢皮肤苍白,皮温低,呈持续性,伴胸闷、气短、大汗。心电图：窦性心率（正常心电图）;右上肢血管超声：右侧锁骨下动脉下段、腋动脉、肱动脉血管闭塞（完全性血栓形成）;血压16／10kPa;血糖正常。以“左上肢动脉栓塞”收住入院。患者既往有小儿麻痹症病史,右下肢发育短小、无力,长期扶双拐行走;常伴有右上肢苍白,皮肤发凉,肱动脉、桡动脉、尺动脉脉搏测不到。     

Pathological study of rabbits＇ femoral arteries subjected to gunshot wounds combining with seawater immersion

To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits‘ femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group Ⅰ, n = 10), gunshot wound with seawater immersion for 30 mins (Group Ⅱ, n = 10), and 60 mins group (Group Ⅲ, n =10). Femoral arteries were impacted by 0.38 g steel spheres fired with a 7.62 mm rifle. After being wounded, rabbits in Groups Ⅱ and Ⅲ were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results : The potterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group Ⅰ, the primary-wound-tract and contused areas in Group Ⅱ manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group Ⅱ and Ⅲ. The pathological changes in the shocked area were similar in 3 groups. Conclusions : For gunshot wounds concomitant seawater immersion in rabbits‘ femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.     

Pathological study of rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

I tisestimatedthattheoccurrenceoffirearminjurytogreatarteriesofthelimbsaverages0.07% 2.4%ofallwarinjuries.1Theoccurrenceissimilarinseaorgroundwarfare.2Inseawarfare,thewoundisoftenimmersedintheseawater.3Ithasnotbeenreportedtoourknowledgeintheliteratureaboutthepathologicalchangesoffirearmwoundsconcomitantseawaterimmersioningreatarteriesanditsinfluence onsurgicalrepair.Inthisstudy,weusedrabbitsas theexperimentalmodelwhosefemoralarterywas subjectedtogunshotwoundandthenimmersedintothe seawatertoobs…     

Edited by ZHAO BinPathological study of rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

Objective: To investigate pathological characteristics of gunshot wounds concomitant seawater immersion in rabbits' femoral arteries. Methods: Thirty rabbits were divided randomly into 3 groups: simple gunshot-wound group (Group I, n=10), gunshot wound with seawater immersion for 30 mins (Group II, n=10), and 60 mins group (Group III, n=10). Femoral arteries were impacted by 0.38 g steel spheres fired with a 7.62 mm rifle. After being wounded, rabbits in Groups II and III were immersed in seawater for 30 or 60 mins, but those in Group I were not. At 2, 4, 6, 8, 12 hours following injury, a 40 mm segment of the artery on each side of the gunshot point were excised and observed by light and electron microscopy. Results: The patterns of arterial injuries were mainly contusion and transection. Completely transected artery was classified as primary-wound-tract area, contused area and shocked area. Compared with those in Group I, the primary-wound-tract and contused areas in Group II manifested obvious swelling in the arterial wall especially at the outside 2/3 of the media. Vacuolar structures were often seen in smooth muscle cells of the media. Intercellular space among the smooth muscle cells were filled with homogeneous acidophilic substances. Deep rugae among endothelial cells flattened or rugal folds lost their longitudinal orientation, and marked fibrin and platelet deposition were noticed. No significant difference was detected between Group II and III. The pathological changes in the shocked area were similar in 3 groups. Conclusions: For gunshot wounds concomitant seawater immersion in rabbits' femoral arteries, there was a marked swelling of cells and intercellular space in primary-wound-tract area and contusion area. The influence of these pathological changes on surgical reparation deservers further study.     

等距对称分叶法吻合小血管的实验及临床应用研究

目的：吻合口管壁等距对称分叶后吻合小血管，确保吻合口管壁完全外翻；内膜平整对合，降低血管危象的发生率，提高通畅率。方法：将吻合口管壁纵形剪开分叶，剪开的深度为管壁厚的２倍，小血管分３叶者吻合６针，４叶者８针。用二定点法先缝合叶部，后缝合２叶之间。用此法共吻合大白鼠尾动脉１００个吻合口，免股动脉和肱动脉１２０个吻合口，免耳皮瓣自体交叉移植２０个，用此法进行断手指再植１５例，游离皮瓣移植５例。结果：１００个大白鼠尾动脉吻合后即刻通畅率为１００％，１２０个股、肱动脉吻合后３周其通畅率为９７．５％（３个吻合口因伤口感染栓塞），吻合前、吻合后３周时吻合口内径经ｔ检查无显著差异（Ｐ＞０．０５），兔耳皮瓣全部成活，临床应用２０例全部成功。未发生血管危象。吻合口经扫描电镜观察，愈合过程优于端端吻合法。结论：此法吻合微小血管能确保其吻合口管壁外翻，内膜平整对合，减少缝合针数。有利于吻合口的无创操作，使血管的通畅率提高，血管危象减少     

梯形对称二等分叶法吻合小血管

目的　探索一种安全、快捷的小血管吻合方法。方法　将吻合口管壁两侧 0°和 180°位斜形4 5°对称剪去一小等腰三角形管壁 ,剪去三角形的各边为血管管径的 1/3,使吻合口管壁前后呈梯形对称二等分叶 ,先用两定点缝合法吻合 0°和 180°位叶间 ,而后缝合梯形叶部和梯形叶边。结果　大鼠尾动脉 2 0个吻合口、颈总动脉和股动脉 4 0个吻合口 ,即刻通畅率 10 0 %。大鼠颈总动脉和股动脉吻合口近期通畅率 (2周 )为 10 0 % ,吻合前后血管口径无明显狭窄 (P >0 0 5 )。吻合口经光镜及扫描电镜观察愈合过程良好。临床应用 2 4例全部成功 ,未发生血管危象。结论　该法吻合小血管克服了对端吻合法中两定点吻合时进针困难的缺点 ,最大限度地减少了血管内膜损伤机会 ,避免了小血管吻合时误穿对侧管壁的弊端 ,确保吻合口管壁完全外翻 ,内膜平整对合。该法操作简单 ,吻合速度快 ,通畅率高 ,可减少血管危象发生 ,值得临床推广应用     

A decade of civilian vascular trauma in Kosovo

ABSTRACT: Purpose We sought to analyze the results of arterial injury management in a busy metropolitan vascular unit and risk factors associated with mortality and morbidity. Patients and methods We analyzed 120 patient with arterial injury treated between year 2000 and 2010 at the University Clinical Center of Kosovo. Seven of these years were prospective and three retrospective study. RESULTS: The mechanism of arterial injury was stabbing 46.66%, gunshot wounds in 31.66%, blunt in 13.33%, and landmine in 8.33%. The most frequently injured vessel was the superficial femoral artery (25%), followed by the brachial artery (20.9%), crural arteries (13.1%), forearm arteries (14.3%), iliac arteries (7.5%), abdominal aorta (3.3%), common femoral artery (3.3%) and popliteal artery (3.3%). Associated injuries including bone, nerve and remote injury (affecting the head, chest, or abdomen) were present in 24.2% of patients. The decision to operate was made based on the presence of "hard signs" of vascular trauma. Arterial reconstruction was performed in 90.8% of patients, 5.8% of patients underwent primary amputation and 3.2% died on the operation table. Overall survival rate was 95.8%. CONCLUSION: Injuries to the arteries are associated with significant mortality and morbidity. Mechanism of injury (blunt, gunshot, landmine or stub), hemodynamic stability at the admission, localization of injury, time from injury to flow restitution, associated injuries to the structures in the region and remote organs are critical factors influencing outcome.     

Five-year experience with PTFE grafts in vascular wounds

From 1978 through 1983, 206 patients had 236 polytetrafluoroethylene (PTFE) grafts inserted in vascular wounds. More than 85% of injuries were due to gunshot wounds, shotgun wounds, or stab wounds. Arterial grafts were inserted into vessels of the upper extremity (38.8%), lower extremity (46.1%), neck and chest (8.8%), and abdomen (6.3%). Grafts were most commonly placed in the brachial or superficial femoral arteries. Venous grafts were more commonly inserted into vessels of the extremities (96.7%), with the majority located in the superficial femoral vein. PTFE was found to be an acceptable prosthesis for interposition grafting in arterial wounds, but long-term patency was less than that seen when interposed saphenous vein grafts are used. Early and late occlusions were a significant problem with 4-mm PTFE grafts in the brachial artery, and this size is not recommended in this location. Peripheral PTFE graft infection did not occur in the absence of exposure of the graft or of osteomyelitis. Exposed grafts did not fare well and early coverage is recommended, even with extensive soft-tissue wounds around the graft. PTFE grafts inserted in proximal extremity veins are excellent temporary conduits which decrease hemorrhage in blast cavities and fasciotomy sites, but all grafts studied by venography at 7 to 14 days were either narrowed or occluded.     

The surgical treatment of arterial injuries in the civilian population.

During an 8-year period, 191 consecutive patients were treated for arterial injuries. Blunt trauma occurred in 46 patients (24%), low velocity gunshot wounds in 82 patients (43%), shotgun wounds in 22 patients (12%), stab wounds in 20 patients (10%), iatrogenic injury in nine patients (5%), high velocity gunshot wounds in two patients (1%) and other penetrating wounds in ten patients (5%). Preoperative arteriography was performed in 48 patients (25%) who were hemodynamically stable with injuries to major vessels in the thorax, base of neck or extremities and in whom the exact location or extent of injury was unknown. Surgical repair was performed in 184 of 191 patients (96%); seven patients expired intraoperatively before reconstruction could take place. Repair was accomplished in the 184 patients by end-to-end primary anastomosis in 80 patients (44%), lateral sutures in 21 patients (11%), SVG in 71 patients (85%) and Dacron prosthesis in 13 patients (15%). One hundred seventy patients survived (89%) and 21 patients died (11%), seven of the 21 deaths were intraoperative and ten others were due to the effects of trauma to the aorta or its branches.     

Comparison of continuous and interrupted suture techniques in microvascular anastomosis.

We evaluated the efficacy of the continuous suture technique (CST) in arteries and veins with varying external diameters (ED). In study 1 a direct end-to-end anastomosis was performed in 5 groups of animals (n = 15 in each group): group 1, rabbit carotid artery (ED, 1.8-2.0 mm); group 2, rabbit femoral artery (ED, 1.4-1.6 mm); group 3, rat femoral artery (ED, 0.7-0.9 mm); group 4, rabbit femoral vein (ED, 2.0-2.2 mm); and group 5, rat femoral vein (ED, 1.0-1.2 mm). In study 2 a graft from the femoral vein was interposed into the carotid artery, with a ratio of the diameter of graft to artery of 1.3:1 in the rats (group 6, n = 12) and 1:1 in the rabbits (group 7, n = 12). In each animal the vessel on one side was repaired using CST and the opposite vessel using the interrupted suture technique. Vessel samples were harvested 1, 2, and 4 weeks after anastomosis. The CST significantly reduced anastomosis time by up to 47% in arteries and 41% in veins. Bleeding time and blood loss were also significantly reduced with CST. Similar results were found in study 2. The total thrombosis rate was 8%, but no significant patency difference was noted between the CST and the interrupted suture technique in any vessel category. We conclude that the CST is a reliable and time-saving procedure in microvascular anastomosis of arteries with diameters greater than 0.7 mm and of veins with diameters greater than 1.0 mm.     

Intimal tears and their relationship to long-term patency in the rat femoral artery

The prognostic importance of arterial intimal tears is not certain in the long term. We have developed a model to evaluate pure intimal damage in the absence of other soft tissue injury or arterial anastomoses to study the effect of isolated traumatic arterial intimal tears. Groups of ten rats each were examined at 1, 2, 4, 8, and 48 weeks and were shown to have no incidence of thrombosis of the femoral artery following traumatic intimal tears. Histologically, there was persistence of medial disorganization and smooth muscle hypertrophy up to 48 weeks. We feel that intimal lesions alone do not predispose a rat femoral artery to thrombosis but might do so in the presence of significant soft tissue injury or an arterial anastomosis.