上臂主干动脉损伤治疗42例

目的 探讨进一步完善上臂主干动脉损伤的治疗方案.方法 对42例上臂主干动脉损伤的患者进行治疗.其中1例为左锁骨下动脉损伤后出现广泛动、静脉瘘,在介入治疗下行封堵;其余41例均行动脉探查术.结果 手术治疗患者中37例(占90.2%)肢体远端血供恢复良好,但血管完全开通仅25例(占61.0%),部分开通12例(占29.2%).Fogarty球囊取栓管取栓组(14例),血管完全开通12例(占85.7%);非取栓组(27例),血管完全开通13例(占48.1%),两组比较差异有统计学意义(P<0.05).结论 上臂主干动脉损伤侧支建立较好,远端血管床血栓常被忽视,手术修复动脉时应常规进行Fogarty球囊取栓,避免残留血栓造成术后再阻塞;如去除血管较多,可行自体或人工血管移植,术后给予抗凝治疗.

Treatment of major artery injuries in the arm: report of 42 cases

Objective To explore a better treatment strategy for major artery injuries in the arm. Methods Forty-two cases of major artery injuries in the arm were retrospectively analyzed. Among these one patient developed arterovenous fistula following injury to the left subclavian artery, which was treated by interventional blockage. Surgical exploration was carried out in the rest 41 patients. Results Among the surgically treated patients, 37 (90.2%) regained distal blood supply postoperatively. However complete revascularization was seen only in 25 of them (61.0%). The other 12 patients (29.2%) had partial vascular pateney. There were a total of 14 patients who received Fogarty balloon catheter thrombectomy. Among them, 12 patients (85.7 %) regained complete vascnlar patency. Thirteen out of twenty-seven patients (48.1%) who received conventional surgery regained complete blood flow. The difference between the thrombectomy group and the conventional surgery group was statistically significant (P<0.05). Conclusion Collateral circulation develops well when major arteries in the arm were damaged. As a result, the ischernic symptoms of the distal extremity were usually unapparent. Thus in order to avoid re-occlusion caused by residual thrombus, thrombectomy of distal arteries should be applied as a routine revascularization procedure to those patients. If too many vessels have been removed, autolngous or artificial vessels should be grafted. Anticoagulatives should be given after the operation.