临时血管内转流术在肢体血管损伤修复中的应用

目的：探讨临时血管内转流术在治疗血管损伤中的价值。方法：总结2006年6月—2013年6月采用临时血管内转流术的血管损伤患者临床资料。结果：全组5例患者，共9条肢体血管受损（3例因外伤、2例因肿瘤切除手术）。5例患者共 8条临时血管内转流管（动脉5条,静脉3条）置入受损血管快速重建肢体血运，然后再行创面的处理及骨折手术；转流时间2~3 h，移除转流管后采用自体大隐静脉移植行血管重建术。全组无死亡，术后1例发生缺血肌挛缩，1例并发下肢深静脉血栓。结论：临时血管内转流术可快速重建肢体血供，缩短肢体缺血时间，为其他合并损伤的处理提供了条件。

     

微创技术结合外科手术治疗重症下肢缺血

目的 探讨术中血管微创治疗技术结合外科手术治疗重症下肢缺血的初步临床经验。方法 1999年7月至2000年10月,采用术中同时行髂动脉腔内微创治疗技术(球囊扩张和支架植入)结合肢体远端动脉重建术治疗广泛多节段动脉硬化闭塞症15例(20条肢体)。结果 术中17条髂动脉微创介入治疗均获成功,11条肢体同时行股-腘动脉人工血管旁路术,3条肢体行股-股-腘动脉人工血管旁路系列转流术,5条肢体行股深动脉成形术。其中有1条肢体股-腘动脉旁路术失败。本组患者无重要脏器并发症和手术死亡。平均随访时间8个月(1-16个月),髂动脉腔内支架通畅率100％,3条股-股动脉耻骨上人工血管转流均通畅,而股-腘动脉人工血管通畅率78．6％,截肢率10．0％。结论 术中髂动脉腔内微创介入治疗技术同时结合远端动脉重建术是治疗广泛多节段动脉硬化闭塞症的害全右特肯沸．     

腋-腋动脉人工血管转流术在血管外科疾病53例中的应用

目的：探讨腋－腋动脉人工血管转流术在血管外科疾病中应用的价值。方法：回顾性分析，总结8年间行腋－腋动脉人工血管转流术的53例患者的临床资料。其中单侧锁骨下动脉闭塞46例；锁骨下动脉瘤3例，锁骨下动脉创伤4例，仅有肢体缺血症状的33例；同时伴有锁骨下动脉窃血症状的18例，2例真性动脉瘤患者无缺血和窃血症状。结果：53例患者术后上肢缺血及锁骨下动脉窃血症状消失，动脉瘤得以根治，患肢动脉搏动恢复正常，双侧肱动脉压力差均小于或等于10mm Hg，无任何手术并发症发生，治愈率为100％，39例得到术后随访，随访率为74％，平均随访时间3年3个月，所有转流人工血管均通畅良好。结论：腋－腋动脉人工血管转流术是一种方法简单易行，创伤小，风险低，并发症少，手术时间短，术后恢复快的术式，特别适合于有严重心脑血管疾病，年老，体弱或锁骨下动脉起始部难以显露，分离的患者。     

自体大隐静脉转流术治疗胫骨平台骨折合并腘动脉损伤疗效分析

目的 探讨自体大隐静脉转流术治疗胫骨平台骨折合并腘动脉损伤的疗效。方法回顾性分析2018年1月至2021年1月收治的15例胫骨平台骨折合并腘动脉损伤患者的临床资料。术前8例行CTA, 7例行彩色多普勒超声检查,提示腘动脉管腔部分闭塞6例,腘动脉管腔全部闭塞9例。所有患者均一期行腘动脉探查并自体大隐静脉转流术、跨膝关节外固定支架固定术,二期行切开复位内固定手术。术后定期随访,观察患侧肢体踝肱指数、皮肤温度、膝关节活动度等指标。结果 本组均顺利完成一期腘动脉探查修复联合跨膝关节外固定支架固定术,术中探查见腘动脉断裂3例,腘动脉内膜损伤4例,腘动脉全层损伤8例。自体大隐静脉-腘动脉端端吻合术3例,自体大隐静脉-腘动脉旁路转流术12例。手术时间180～299 min,平均(243.53±33.72) min。术后患肢远端血液循环均稳定,术后即刻彩色多普勒超声提示肢体远端动脉血流通畅,无血管危象发生。术后均随访6个月,随访期内自体大隐静脉桥均未出现狭窄或闭塞。术后第1、6个月患肢踝肱指数及皮肤温度较术前明显改善(P<0.01),术后第6个月膝关节活动度较术后第1个月明显改善(P<0....     

股／腘静脉损伤的手术治疗

目的探讨股／腘静脉损伤的手术治疗方法。方法1998年4月至2007年5月治疗股／胭静脉损伤26例。单纯静脉伤12例，合并股／腘动脉损伤14例，分别采用血管修补术、血管补片修复、端端吻合术、大隐静脉移植及“并管法”大隐静脉移植修复动、静脉。结果23例肢体术后血运恢复。合并股／腘动脉损伤14例中，1例并发肾功能衰竭，3例肢体坏死截肢，4例肢体肌肉部分坏死清创后残留部分功能障碍，单纯股／胭静脉损伤者血管修复后肢体无显著肿胀，血运良好。随访3个月～7年，23例肢体血运良好。结论股／腘静脉损伤修复有助肢体恢复正常血供，优先处理合并动脉损伤，“并管法”大隐静脉移植修复股／腘静脉损伤有一定临床使用价值。     

人工血管移植感染的显微外科治疗

目的 报道人工血管移植感染显微外科治疗的临床疗效. 方法 从1998年1月至2008年12月,应用健侧肢体血管桥式交叉供血营养患肢治疗人工血管移植感染8例,其中股动、静脉4例.腘动、静脉2例,腋动、静脉2例. 结果 术后随访3年,所有肢体血液供应良好,肢体外形及功能恢复. 结论 应用健侧肢体血管桥式交叉供血营养患肢可有效恢复人工血管移植后感染肢体的血液供应,降低截肢率.     

腘动脉陷迫综合征26例外科诊疗经验

目的总结腘动脉陷迫综合征(PAES)的外科治疗经验。方法回顾性分析北京协和医院2006年3月至2016年1月收治的26例PAES患者(共34条肢体)。病变的肢体中,有4条仅仅为肌肉组织压迫造成,无器质性狭窄,1条肢体在狭窄后出现动脉瘤,余均表现为腘动脉管壁增厚或腔内血栓形成。2条肢体行大隐静脉原位转流术,19条肢体行静脉补片或人工补片成形联合异常肌束切除术,4条肢体行单纯的腘动脉手术松解,另外4条肢体先行插管溶栓术,再行腘动脉松解,5条肢体行病变血管切除、自体大隐静脉间位移植术。结果补片成形术组动脉1年通畅率94.7%;单纯腘动脉松解组1年通畅率75%;大隐静脉原位转流术肢体(2条)术后通畅率100%;插管溶栓术肢体(4条)术后通畅率50%;腘动脉松解联合大隐静脉间位移植术(5条)1年通畅率80%。结论 PAES是血管外科诊疗的一大难点。多种术式中,切开取栓、内膜剥脱联合补片成形术的中长期疗效显著;如病程短、探查腘动脉通畅,单纯肌束切除解压能达到治疗目的;如病变节段过长,仅仅解除腘动脉压迫及内膜剥脱创伤大、效果不显著,行大隐静脉原位转流术和间位移植术效果较好。     

腘动脉闭塞的手术治疗经验

目的 探讨单纯腘动脉闭塞的外科治疗的策略及效果.方法 回顾性分析2007年6月至2008年6月25例单纯腘动脉闭塞患者手术治疗的临床资料.男性18例,女性7例;年龄17～83岁,平均(53±21)岁.急性缺血11例11条肢体(42.3%),慢性缺血14例15条肢体(57.7%).手术方式包括腘动脉取栓4条肢体,补片成形19条肢体,自体静脉旁路或间位移植2条肢体.人工血管间位移植1条肢体.其中6条肢体在血管重建手术同期行腓肠肌内侧头离断松解术.结果 本组患者手术均获成功,24例患者25条肢体症状改善,间歇性跛行距离延长;术后踝肱指数为0.75±0.29,高于术前的0.35±0.20(P<0.01).随访4～16个月,平均10.2个月,一期通畅率为92.3%;术后截肢3例,保肢率为88.5%.结论 腘动脉闭塞成因复杂,采取个体化手术治疗策略方能获得满意疗效.     

腘动脉陷迫综合征10例外科诊治分析

目的总结腘动脉陷迫综合征的诊断及治疗经验。方法回顾性分析吉林大学中日联谊医院2012年1月至2018年7月期间诊治的10例(10条肢体)腘动脉陷迫综合征患者的临床资料。结果 10例腘动脉陷迫综合征患者中初诊症状7例为间歇性跛行,3例为急性下肢动脉缺血。9例术前超声和(或)计算机体层摄影血管造影均见腘动脉闭塞(6例明确诊断),其中7例行自体大隐静脉间位移植术,1例行腘动脉人工血管移植重建,1例行腘动脉取栓术后3 d闭塞而再次手术探查明确诊断后行股-腘动脉人工血管移植重建;另外1例入院后行数字减影血管造影后直接行置管溶栓和球囊扩张术后效果不佳而再次术中明确诊断后行肌束切除加腘动脉补片成形术。10例术后彩色多普勒超声随访3～12个月,1例自体大隐静脉间位移植远端吻合口端侧吻合重建患者术后1个月闭塞,1例腘动脉人工血管移植重建患者术后3个月闭塞,其余8例患者均通畅。结论手术治疗是腘动脉陷迫综合征唯一有效的根治治疗方式,完全闭塞病变采用自体大隐静脉间位移植重建的通畅率较高。     

髂外-腘动脉人工血管交叉转流术治疗髂股动脉硬化闭塞症

目的 探讨髂外动脉-腘动脉人工血管移植交义转流术治疗单侧髂股动脉硬化广泛性闭塞的疗效.方法 1999年9月至2007年10月39例患者经血管彩超、CT血管造影(CTA)或数字减影血管造影(DSA)检查,证实单侧髂股动脉硬化广泛性闭塞;静息痛25例,14例足趾溃疡或坏疽,平均踝/肱指数0.19;采用健侧髂外动脉-患侧胴动脉人工血管移植交叉转流术,左转至右22例,右转至左17例.结果 围手术期无死亡及截肢患者.踝/肱指数由术前平均0.19术后升至0.94;术前以80 m/min速度行走,跛行距离15～60 m,术后(100～120)m/min行走,距离增至350～500 m或>500 m;术后血管彩超检测胭动脉平均血流速为45 cm/s,胫前(后)动脉术前极少量血流信号,术后平均血流速41 cm/s.35例(89.7%)平均随访3.4年,3年一二期累计通畅率85.7%,其中4例截肢,保肢率88.6%.结论 髂外动脉-腘动脉人工血管移植交叉转流术是治疗单侧髂股动脉闭塞可行有效的方法,尤其适宜全身状态较差,合并有重要器官病变的老年患者.     

Temporary intravascular shunt in complex extremity vascular injuries

BACKGROUND: Early revascularization of ischemic limbs is an important step in the management of complex extremity vascular injuries (CEVIs). We present our experience of using a temporary intravascular shunt (TIVS) in the management of patients with limb-threatening vascular injuries. METHODS: Patients who had CEVIs at our institution from January 1996 to December 2000 were treated with early insertion of a TIVS at the initial phase of operations. The TIVSs were assembled from simple intravenous and extension tubes available in the operating room. Rigid stabilization of the injured bones and/or joints, debridement of the devitalized soft tissues, saphenous vein harvest for interposition grafts, and repair of any associated venous injuries were performed while the shunts were in place. Then, the shunts were removed and the injured arteries were repaired. RESULTS: There were five men and two women in this series. The preoperative time ranged from 120 to 450 minutes (median, 390 minutes). All TIVSs were inserted within the initial 30 minutes of operation. The injured arteries were popliteal (five patients), common femoral (one patient), and brachial arteries (one patient). Three patients also had associated venous injuries (i.e., two popliteal veins and one common femoral vein). Six injured arteries were repaired with reversed saphenous vein grafts and one (popliteal artery) was repaired by end-to-end anastomosis. The shunt time ranged from 60 to 180 minutes (median, 120 minutes). One patient had a TIVS inserted into both injured popliteal artery and vein. The operative time ranged from 225 to 360 minutes (median, 285 minutes). No complications related to shunt insertion were observed and all limbs could be salvaged. CONCLUSION: A self-constructed shunt is inexpensive, safe, and convenient to insert. Early revascularization of the injured limb with a TIVS can eliminate the adverse effects of prolonged ischemia and enables the surgeons to manage other associated injuries in an unhurried manner. We recommend early insertion of TIVSs in CEVIs.     

四肢主干动脉外伤缺损长度的判断与修复重建

目的：研究四肢主干动脉损伤实际缺损长度、缺损裂隙宽度对修复重建选择的影响。方法：回顾性研究1996年至2009年治疗的32例四肢主干动脉损伤患者,其中男30例,女2例;成人30例,年龄18～51岁,平均36岁,儿童2例,年龄分别为4岁和5岁。受伤部位：腋动脉4例、肱动脉7例、桡动脉2例、股动脉4例、腘动脉13例和胫后动脉2例。观察分析动脉损伤后缺损裂隙的宽度以及形成原因,对所有病例采取了血管拉伸后端端吻合的方法进行修复。结果：动脉缺损裂隙宽度3～7 cm,平均（4.375±1.200） cm,上肢肱动脉和腋动脉11例（5.73±0.63） cm,下肢股动脉和腘动脉17例（3.80±0.73） cm,胫后动脉2例（3.25±0.35） cm,桡动脉2例（3.00±0.00） cm.上肢肱动脉和腋动脉缺损间隙宽度大于其他3个部位（P<0.01）.所有患者血管端端吻合成功,血运恢复良好。因肢体感染后期截肢2例。所有患者得到随访,不伴骨折患者随访至术后2周,伴骨折患者至少随访1年,所有患者肢体血运良好。结论：血管缺损裂隙宽度不同于实际血管缺损,而是大于实际血管缺损,对血管缺损长度的错误判断将导致更多的血管移植。绝大多数的血管外伤缺损可以通过血管游离,拉伸延长后直接修复。     

上肢热压伤合并主干血管损伤的治疗

目的探寻肢体热压伤合并主干血管损伤的治疗方案。方法对8例上肢严重热压伤合并骨筋膜室综合征患者实施减压术，但对肢体血运的改善不明显。行血管探查得知患肢均合并肱、桡、尺动脉或掌深、浅弓损伤，采用直接吻合、屈曲肢体吻合、大隐静脉移植等方式修复血管并移植中厚皮片或带蒂胸脐皮瓣封闭创面。结果l例肱动脉修复后创面植中厚皮片者因无良好的软组织覆盖，术后4周血管再度栓塞导致上臂中段截肢。7例血管修复后创面移植皮瓣的患者肢体血供完全恢复并得以完整保留。结论及时行血管探查和修复以及选择周围良好的软组织覆盖，是治疗热压伤合并主干血管损伤的关键措施。     

Civilian vascular trauma of the upper extremity

One hundred forty-three patients with 163 upper extremity vascular injuries were reviewed. Penetrating trauma accounted for 94% of the injuries and blunt trauma for 6%. Absent pulses are not a completely reliable sign of upper extremity arterial injury. The most frequently injured upper extremity vessel is the brachial artery, followed in decreasing frequency by ulnar, radial, and axillary arterial injuries and axillary venous injuries. The most common technique of vascular repair was end-to-end anastomosis, followed by vein graft interposition. No amputations were required. Despite excellent results of vascular reconstruction, functional impairment due to associated nerve injuries was a distressingly predominant finding.     

Vascular injuries of the axilla.

Between January 1970 and December 1980, 65 patients sustaining 85 vascular injuries of the axillary artery and/or vein were managed at the Ben Taub General Hospital in Houston, Texas. Concomitant injuries of the subclavian and/or brachial vessels were noted in 34 per cent of patients. A variety of exposure techniques was used in approaching the axillary vessels. Emphasis upon preservation of collateral vessels led to an increased use of substitute vascular conduits over end-to-end anastomosis. The ready availability of prosthetic conduits, absence of graft infection, and excellent short-term patency have made them a primary choice for axillary arterial reconstruction in our recent experience. Associated brachial plexus injury (35%) accounted for the most significant long-term morbidity. The operative mortality was 3.1%, and one patient required upper extremity amputation following failure of repeated revascularization attempts.     

Axillary artery injury from humeral neck fracture: a rare but disabling traumatic event

Axillary artery injury from blunt trauma to the shoulder is uncommon. Fracture of the neck of the humerus is a rare cause of injury to the axillary artery. Four cases of axillary artery thrombosis from humeral neck fracture are reported. Each of the first 2 patients presented with a pulseless and acutely ischemic limb after a trivial fall. A repair of the axillary artery with saphenous vein interposition graft was performed in the first patient. The extremity was salvaged, but a residual radial and ulnar neurologic deficit persisted. The second patient presented with a pulseless insensate upper extremity accompanied by motor loss. He underwent primary axillary artery repair. Still early in his postoperative course, he has had global brachial plexopathy and is undergoing intensive physical therapy. The third patient had a delayed presentation of brachial plexopathy and sympathetic reflex dystrophy. Arterial reconstruction was not required owing to excellent collateralization. The fourth patient presented with a cool pulseless extremity. His recovery is nearly complete after bypass of the axillary artery with a reversed saphenous vein graft. In addition, a review of the literature revealed 24 cases of axillary artery injury associated with humeral neck fracture. The mean age was 66.6 years. The most common mechanism of injury was a fall (79%). Thirteen patients (46%) presented with a neurologic deficit. Acute ischemia was present in 68%. Physical examination predicted the arterial injury in all but 1 patient. The injured axillary artery was repaired in 26 cases. Revascularization by an interposition graft was the most common procedure. All grafts and reanastomoses were patent and led to limb salvage. Of 9 primary repairs, 3 amputations were performed. Although limb salvage rate was 89%, a good functional outcome was obtained in only half of the patients. A high index of suspicion is required for early diagnosis of axillary artery injury. Despite excellent results of vascular reconstruction, the outcome remains determined by the excessive neurologic morbidity. Recognition of the associated brachial plexus injury is essential to improve the functional outcome of this unusual arterial injury.     

人工血管在臂丛神经合并血管损伤中应用的临床初步研究

目的研究人工血管在臂丛神经合并血管损伤中应用的可行性和优点。方法2004年2月-2004年10月，对6例臂丛神经损伤合并大动脉损伤的患者，进行臂丛修复和人工血管移植修复。人工血管移植长度为7～18cm，平均12．3cm。结果术后桡动脉搏动良好，随访3-6个月，B超证实血管通畅率为100％。2例臂丛束支部不全损伤松解术后上肢功能恢复良好。结论臂丛损伤同时合并有血管损伤时，采用神经、血管同步修复，有望术后改善患肢的血运，提高臂丛治疗的效果。     

纵向生物力学特性对动脉损伤修复方法选择的影响

目的 研究人体四肢主要动脉不同长度损伤与修复方法选择之间的关系，比较由于因管纵向性物力学特性面产生的修复差异，为临床修复效果及近，远期疗效评价提供依据。方法 回顾分析应用端端吻合法和自体静脉移植法修复的四肢主要动脉伤共１７７例１８５条血管，对相同损伤部位而不同修复方法的血管的真性缺损长度做ｔ检验比较，通过９５％置信区间分析两种修复方法的选取界限。对自体静脉移植修复血管中真性缺损长度做ｔ移植长度做线     

Free functioning gracilis transfer for brachial plexus reconstruction using the internal mammary vessels as recipients: A case report

Adult brachial plexus injuries are often associated with concomitant trauma to the axillary or subclavian vessels. In patients planned for free functioning gracilis transfer (FFGT) this poses a challenge to reconstructive surgeons where using the standard donor vessels can lead to endangering the circulation in the affected extremity or risk flap loss due to the poor perfusion pressures. This case report describes the use of a FFGT for upper limb reconstruction in a 22-year-old patient with a pan plexus injury and concomitant axillary artery injury following a high energy motorcycle accident. Ipsilateral internal mammary vessels were used as donor vessels after removing the 3rd and 4th costal cartilages. The gracilis muscle was harvested in its whole length, including a small transverse skin paddle, and transferred to the upper extremity. It was secured to the clavicle proximally, weaved into the Flexor Digitorum Profundus tendons distally and neurotised by the spinal accessory nerve. The procedure and postoperative course were uneventful and the follow up at 18 months showed MRC grade 4 in elbow flexion with only a slight contour deformity at the donor chest site. This is the first report demonstrating the use of internal mammary vessels for FFGT reconstruction in the upper extremity after removing two costal cartilages to achieve sufficient pedicle length.