多发伤患者的肢体主干血管损伤修复手术67例

目的 对67例伴有肢体主干血管损伤的多发伤患者的血管手术进行回顾性分析。方法 根据患者肢体缺血时间长短、部位及多发伤伤情，分别采用端端吻合、血管移植、修补、结扎或分流术等手术9l例次。结果 除2例患者死亡外(分别死于术前脑疝、失血性休克及术中甲亢危象)，3例患者分别在术后6、7、12h，出现血管危象(动脉痉挛危象2例，静脉危象l例)，经对症治疗及手术探查解除危象，各有l例患者术后7、12d出现肺炎及急性肾功能衰竭多尿期，后治愈。结论 对伴有肢体主干血管损伤的多发伤患者，在急诊实施抢救性脏器手术的同时或先后．应尽快行肢体血运重建手术．应特别注意对多发伤患者伴有的闭合性主干血管损伤的诊断和修复、注意术中凝血象检测及术后抗凝治疗．

Surgical repair of major vascular injuries in the extremities complicated by other injuries: retrospective analysis of 67 cases]

OBJECTIVE: To retrospectively analyze the surgical repair of injured major vessels in the extremities complicated by multiple other injuries. METHODS: According to different time lengths of sustaining ischemia, sites of the major vascular injuries and conditions of other injuries, 91 operations for end-to-end anastomosis, vessel grafting and repair, ligation and shunting respectively were performed on the 67 patients. RESULTS: Except for 2 fatal cases (one due to preoperative brain hernia and hemorrhagic shock, the other to thyroid crisis during operation), all other cases survived the operations. Vascular crisis occurred in 3 cases (2 arterial spasm and 1 venous crisis) 6, 7 and 12 h respectively after the operations, which were relieved by appropriate treatments and surgical explorations. One patient developed pneumonia and acute renal failure with polyuria at postoperative days 7 and 4 respectively, but full recovery was achieved. CONCLUSIONS: For patients with major vascular injuries in the extremity complicated by multiple other injuries, timely revascularization of the extremities should be performed during or immediately after emergency operations of the vital organs. Particular attention should be given to the diagnosis and repair of closed major vascular injuries in such patients, who need to be monitored for blood coagulation during operation and should receive due post-operative anti-coagulation treatment.