改形静脉移植修复两端口径悬殊的四肢血管损伤

目的　探讨利用静脉分支成形和双股静脉成形扩大移植静脉吻合口技术,提供两端口径不等的自体静脉移植体,修复两端口径悬珠和大口径的四肢血管缺损。　方法　设计“漏斗样”、“雨披样”和“错位Y形”成形方法,以离体血管完成实验。临床取带分支的自体大隐静脉、小隐静脉及前臂静脉成形移植,用于髂外静脉、股动静脉和动静脉损伤的修复和断指再植,以及口止母趾甲瓣移植,共36例。其中急诊手术35例,择期手术1例。移植血管长度1.0～15 .0 cm。　结果　“漏斗样”成形可使静脉吻合口口径扩大0 .5 0～1.2 5倍;“雨披样”成形可满足四肢各种口径血管的修复需要;“错位Y形”吻合口成形可提供粗大的静脉移植体。移植的36条静脉,通畅35条,肢体血供正常。　结论　利用静脉分支,采用“漏斗样”和“雨披样”成形及扩大移植静脉吻合口和双股静脉“错位Y形”成形,是修复两端口径悬殊的和大口径的四肢主要血管损伤的理想方法。     

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     

颈外浅静脉移植在下肢大血管缺损的临床应用

目的 报道颈外浅静脉移植在下肢大血管缺损的临床应用效果。方法 临床应用颈外浅静脉移植治疗下肢大血管缺损20例。其中感染性股动脉瘤11例，外伤性股动脉瘤4例，腘动脉损伤3例、腰静脉损伤2例。结果 术后随访3个月～5年，全组病例吻合口通畅。吻合段血管无栓塞、无破裂出血、无动脉瘤复发。结论 在下肢大血管损伤性缺损或感染性股动脉瘤的治疗中，可首选颈外浅静脉移植。效果良好。     

Y型静脉搭桥术的临床应用

为了探讨组织移植时受区无可供吻合血管及复杂性断掌动脉缺损的治疗方法,１９９０年１月～１９９６年７月,采用Ｙ型静脉移植搭桥修复合并血管损伤的组织缺损、复杂性组织缺损及重建挤压撕脱性断掌血运。临床应用２３例,小腿前侧皮肤及骨缺损６例,股骨骨折股动脉损伤并组织缺损３例,五指缺失２例,复杂性断掌１２例。结果表明,１５个移植组织及１２例再植肢体全部成活,无一例感染及坏死。经１年～５年随访,肢体功能恢复良好,１９例恢复了原工作。认为,Ｙ型静脉搭桥术是克服组织移植及复杂性断掌血管缺损的一种较理想的方法。     

静脉移植在断指（肢）及血管损伤中的应用

1985年以来,我科共做断指(肢)再植45例58个断指(肢),修复四肢血管损伤12例,对其中20例因动脉缺损不能直接吻合者应用自体浅静脉移植修复,重建动脉血运,取得较好效果,报道如下。     

血管吻合与空肠移植在食管外科中的应用

采用空肠系膜血管吻合，施行空肠移植术修复各种类型的食管胃缺损１８例。其中２例采用甲状腺上动脉与肠系膜动脉吻合，１６例采用颈横动脉与肠系膜动脉吻合，全组１８例均采用颈外浅静脉与肠系膜静脉吻合。带蒂空肠移植７例，游离空肠移植１０例，游离空肠片移植１例。全组无手术死亡。文中就手术适应证及手术技术进行了讨论。     

一条静脉移植修复手掌动脉弓或手背静脉网缺损

严重外伤所致手掌动脉弓或手背静脉网毁损较难处理，目前均采用自体血管移植进行修复，方法很多〔１～３〕，效果不一。我院自１９８８年以来，用１条四肢浅静脉移植修复手掌动脉弓及手背静脉网的缺损取得良好的效果。临床资料本组１５例，男９例，女６例。年龄１８～３２...     

静脉移植治疗四肢动脉损伤33例

静脉移植治疗四肢动脉损伤３３例张敏罗治师梁胜根我院自１９８２－１９９５年共收治四肢动脉损伤４７例，其中行静脉移植术治疗者３３例（６４．７％），总结如下。临床资料本组男２８例，女５例；年龄最小１４岁，最大４９岁，平均３０．６岁。损伤原因：交通事故１８例...     

大隐静脉移植在修复四肢主干血管缺损中的应用

目的 探讨四肢主干血管缺损的有效治疗方法。方法 1996年1月～2003年5月，采用大隐静脉移植术修复四肢主干血管缺损26例。结果 26例中23例肢体血循顺利恢复正常，3例术后出现血管危象，经行血管探查血栓清除再吻合处理，2例肢体血液循环恢复正常，1例伤口感染并血栓形成致肢体坏死，最后作截肢处理。成活的25例肢体中22例功能恢复正常，3例肢体残存不同程度的功能障碍。结论 大隐静脉口径与四肢主干血管相当，组织相容性好，是修复四肢主干血管缺损的理想材料。     

微型静脉皮瓣桥接断指再植

我院１９９２年９月至１９９８年７月在作者单位：５１１７３８广东省东莞市桥头医院１０５例１７６指断指再植中应用游离微型静脉皮瓣移植或带血管蒂的微型静脉皮瓣转移移植，桥接吻合指背静脉、修复指背皮肤缺损共７例，均获成功。临床资料本组男６例，女１例，年龄１６...     

Use of azygos vein as interposition graft for surgical unifocalization of pulmonary blood supply

Hemodynamic repair in patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries with arborization defects, and major aortopulmonary collaterals necessitates prior unifocalization of pulmonary artery blood supply. When direct anastomosis between these collateral vessels and the central pulmonary arteries is not technically feasible, an interposition graft is required. Dacron, polytetrafluoroethylene, and pericardium have been used for this purpose. We describe our experience with the use of azygos vein as an interposition graft in 3 patients who underwent unifocalization of the pulmonary blood supply to the right lung. Our experience suggests that the azygos vein is a useful graft for use in this specific form of unifocalization procedure.     

Autogenous vein graft repair of injured extremity arteries: early and late results with 134 consecutive patients

Autogenous vein tissue is recognized as the preferred material for extremity revascularizations that require the use of a conduit. However, the results after vascular repair of injured extremity arteries with autogenous vein interposition or bypass grafts have not been well defined. This study was done to determine both the early and late patency and limb salvage rates as well as the graft infection rate of autogenous vein repairs of injured extremity arteries. The records of 134 consecutive patients with acute extremity arterial injuries requiring repair with a reversed autogenous vein graft over a recent 5-year period were reviewed. Follow-up graft patency was defined by the presence of a palpable pulse and an extremity Doppler-derived pressure index of greater than or equal to 0.9 distal to the arterial repair. Cumulative patency was assessed by the life-table method. Acute graft thrombosis occurred in two patients, one of whom underwent successful graft thrombectomy. Four patients (3%) required extremity amputation: one patient with a thrombosed vein graft and three patients with patent vein grafts but nonsalvageable limbs as a result of myonecrosis (2) or osteomyelitis (1). No perioperative graft infections occurred. One hundred twenty-eight patients (97%) had an intact extremity and a patent vein graft at the time of hospital discharge. One hundred three patients (80%) were examined at 30 days, and all grafts were patent. Seventy-three patients (57%) were available for follow-up at intervals exceeding 6 months, and 40 patients (31%) were followed-up for periods exceeding 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

活体肾移植供肾多支血管处理的体会

目的探讨活体肾移植供肾多支血管的处理及重建方法。方法 49例供体,供肾有多支动脉变异45例,有多支静脉变异7例,其中3例为肾动脉、静脉同时多支血管变异。供肾切取术中,对于供血面积直径小于3cm且影响操作的分支动脉,术中即予结扎、离断;多支静脉,如直径为主干的1/3以下且试夹闭该静脉未发现明显淤血等血液回流障碍者,给予结扎、离断。5例采用体外血管重建。受体肾移植术中根据分支动脉管径、长度及位置及受者髂动脉和腹壁下动脉的情况等综合条件来选择受者相应的动脉吻合。结果 48例动脉分支吻合者在开放血流后搏动良好、吻合口通畅,术后1～7d内肾功能恢复正常、术后1～2周彩色多普勒超声检查,提示该分支动脉供血区域丰富。肾静脉分支结扎者未发现淤血现象。1例高龄供肾者发生肾功能延迟恢复。术后无出血、肾动脉栓塞、尿瘘、输尿管坏死和新发高血压等并发症。结论正确处理移植肾多支血管变异,可获得良好移植效果。     

Biomechanical effect of major extremity vessels in choosing repair methods for peripheral artery injury

Objective： To investigate the biomechanical effect of major extremity vessels to choose appropriate repair methods for vascular injuries of the extremities. Methods ： The data of 385 patients （337 males and 48 females, aged 18-71 years, mean = 32.6 years ） including 403 injured vessels, who suffered from vascular injuries of the extremities and were treated in our hospital from October 1960 to August 2005, were studied retrospectively in this article. We compared the results of different repair methods for the defect of vessels and evaluated different injured vessels for repairing arterial injuries with anastomosis and venous graft, respectively. Results： A significant difference was found between the defect lengths of the arteries repaired with anastomosis and venous graft （ P 〈 0. 0001 ）. The upper limits of the confidence interval in the defect lengths of the brachial artery, the femoral artery and the popliteal artery were 3.43 cm, 2. 38 cm and 2. 42 cm, respectively, when repaired with anastomosis. The lower limits were 2.16 cm, 2.16 cm and 1. 63 cm, respectively, when repaired with venous graft. The defect length of each artery repaired with venous graft had linear correlation with the graft length. Conclusion - Because of the longitudinal biomechanical difference of different options of repair arterial injuries. human peripheral vessels, are necessary for different arterial injuries.     

Repair of juxtarenal para-anastomotic aortic aneurysms after previous open repair with fenestrated and branched endovascular stent grafts

Three patients with juxtarenal para-anastomotic aortic aneurysms after previous open abdominal aortic aneurysm repair were treated with custom-designed fenestrated and branched Zenith endovascular stent grafts. Six renal arteries and two superior mesenteric arteries were targeted for incorporation by graft fenestrations and branches. The fenestration/renal ostium interface was secured with balloon-expandable Genesis stents (n = 5) or Jostent stent grafts (n = 1). Completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. During follow-up, one patient developed asymptomatic renal artery occlusion and underwent further endovascular intervention for type I distal endoleak. Computed tomography at 12 months demonstrated complete aneurysm exclusion in all patients with antegrade perfusion in the remaining target vessels. Fenestrated and branched endovascular stent grafts may be an acceptable alternative to conventional open repair in this group of patients.     

Flow patterns and preferred sites of intimal thickening in diameter-mismatched vein graft interpositions

BACKGROUND: It is suspected that blood flow and flow-induced shear stress play an important role in the pathogenesis and localization of intimal hyperplasia in anastomosed vessels. However, experimental data that demonstrate the correlation between the flow and the sites of intimal thickening obtained in the same vessel are scarce. For this reason, we have studied the relationship between the flow and precise locations of wall thickening specific to the particular vessel by performing diameter-mismatched vein graft interpositions. This method created more flow disturbances than those found in our previous study, which was carried out by dividing an artery and simply suturing its ends back to their original positions. METHODS: In the current study, grafting procedures consisting of 26 saphenous vein interpositions and 10 jugular vein interpositions were carried out on the femoral arteries of 22 adult mongrel dogs. The vessels were harvested at 3 months after operation, perfusion-fixed, and rendered transparent. The precise location and the size of intimal thickening and characteristics of the flow, such as flow patterns, distributions of fluid velocity, and wall shear stress, were studied in detail by means of flow visualization and cinemicrographic techniques. RESULTS: It was found that the diameters of interposed saphenous vein grafts, which were about one-half the diameter of host arteries, increased drastically and became almost the same as those of the host arteries. Intimal thickening was found distal to the distal anastomotic junction in smaller diameter saphenous vein-interposed vessels and distal to the proximal anastomotic junction in larger diameter jugular vein-interposed vessels. In both cases, flow was disturbed with the formation of a slow recirculation flow due to a sudden enlargement of vessel diameter caused by a mismatch of vessel diameters at the anastomotic junction and at the location where the wall shear stress was low. CONCLUSIONS: The results suggest that the key hemodynamic factors involved in the localization of intimal thickening are the low velocity of flowing blood and the resultant low shear stress acting on the vessel wall.     

异种血管组织的脱细胞研究

目前,临床上涉及小口径动脉闭塞的血管疾患呈增多的趋势,然而可供选择的移植物却并不多,虽然聚四氟乙烯等材料用于大口径动脉的移植取得了较好效果,但用于小口径动脉移植的远期通畅率却不尽如人意.作为金标准的大隐静脉或自体动脉移植又受到来源、额外手术创伤与经济负担的困扰.组织工程血管的出现有望解决这个难题.以脱细胞的异种血管作为构建组织工程血管用支架目前研究的较为广泛.本文对目前常用的各种脱细胞方法及其相关的问题做一简要综述.     

An experience with upper-extremity vascular trauma

In this 6-year study of 101 limbs requiring surgical intervention for upper-extremity vascular trauma, most patients were male, young, and injured by penetrating objects. Injured vessels included 13 axillary/subclavian, 23 brachial, 40 radial, and 25 ulnar arteries. Concomitant injuries included nerve injury in 50 cases, tendon laceration in 29, and bony fracture in 11. Arterial repair was accomplished by primary repair in 54 limbs, vein graft in 26 limbs, and vein patch in 3 limbs. Seventeen arterial injuries were ligated. Ancillary procedures included 30 nerve or 27 tendon repairs. The limb salvage rate was 99%. No functional deficits were noted in those cases with only a vascular injury. In 64% and 25% of patients with nerve or musculoskeletal injury, respectively, the arm was functionally impaired. Prompt diagnosis and surgical intervention eliminate vascular injury as a factor in upper-extremity limb loss or disability. Functional deficits are the result of nerve or orthopedic injuries.