四肢血管损伤漏诊及再手术的原因探讨

目的探讨四肢血管损伤漏诊及再手术的原因。方法回顾性分析了149例四肢血管损伤病人的诊断和治疗方法,寻找漏诊及再手术的原因。结果漏诊8例,漏诊率5.4%,其中彩超诊断错误1例,因肢端皮温好漏诊4例,因可触及动脉搏动漏诊2例,因锐器割伤裂口自行封闭漏诊1例。再手术(再次血管探查)23例,再手术率15.4%,其中,19例因血管栓塞再次手术,4例因所移植的大隐静脉破裂再次手术。结论彩超并非绝对可靠,肢端皮温好不能排除动脉主干断裂,动脉搏动减弱或消失者主张早期探查血管。早期修复血管、正确熟练的镜下操作是手术成功的关键,对大段血管缺损者建议用人造血管移植修复。

Reasons for the Missed Diagnosis and Reoperation of Acral Artery Injuries

Objective To study the reasons for missed diagnosis and reoperation of artery injury in extremities.Methods One hundred and forty-nine cases of acral artery injuries were reviewed retrospectively.The reasons for missed diagnosis and reoperation were studied. Results Eight cases were missed diagnosed (5.4%).one was missed by colorized ultrasonic examination,4 were for normal skin temperature,2 were for touchable artery impulse,and one were for self-closure of split wound by a pointed weapon.Twenty-three cases (15.4%) were operated again.Nineteen were for artery embolism and 4 were for the rupture of the grafted great saphenous vein.Conclusion Colorized ultrasonic examination was not absolutely dependable.The artery breakage could not be excluded by normal skin temperature of extremity end.The artery injuries should be probed as soon as possible.The successful treatment depends on the early repair of artery and the excellent performance under operation microscope.The manmade artery can be used in the case of large of blood vessel defects.