注射毒品致四肢血管损伤的救治

目的 探讨注射毒品致四肢血管损伤的特点及显微外科治疗的方法与临床疗效.方法 1998～ 2006年间收治因注射毒品致四肢血管损伤病人共31例,其中形成股动脉假性动脉瘤者28例,形成肱动脉假性动脉瘤者2例,因直接注射粉剂毒品致股血管栓塞并下肢湿性坏疽者1例.应用显微外科技术对30例假性动脉瘤形成者清创后进行血管重建治疗,其中行假性动脉瘤切除后直接血管吻合7例,应用静脉片单纯修补4例,大隐静脉移植修复12例,人造血管移植3例,直接行股动脉结扎4例;已经出现湿性坏疽者行截肢术.结果 住院时间11～ 32天,平均19天,全部患者均治愈出院,未出现肢体缺血坏死及血管瘤再次破裂出血.结论 彻底清创是防治感染的根本;自体静脉移植是治疗假性动脉瘤的主要手段,直接行股动脉结扎是在条件困难情况下才选择的术式,本组有限的病例显示其也是一种相对安全的术式,有待更多的临床经验积累.

Treatment of vessel injury of the extremity in intravenous drug abusers

Objective To explore the characteristic of extremity's vessel injury in intravenous drug abusers and their available surgical treatment options.Methods Thirty one cases of extremity's vessel injury in intravenous drug-addict population admitted to our hospitals between 1998 and 2006 were reviewed and analyzed retrospectively.There were 30 patients with infected pseudoaneurysms(28 for femoral artery and 2 for brachial artery)and one developed lower extremity wet gangrene.Twenty-six patients(83.8%)had excision of the pseudoneurysms with revascularization after debridement using microsurgial management,which included 7 cases of direct vascular anastomosis,4 cases of repair with vein slice,12 cases of reverse great saphenous vein graft,3 cases of artificial blood vessel graft,and 4 cases of ligation of the femoral artery.The patient with lower extremity wet gangrene was treated by transfemoral amputation.Results The time of hospitalization ranged from 11 to 32 days,with an average of 19 days.All the patients were cured without any ischemia in the extremities and recurrence of the pseudoaneurysms.Conclusion The thorough debridement is essential to prevent postoperative infection,auto-vein graft is the main method for treating pseudoaneurysms,common femoral artery ligation is an available way when situation is emergent,while the ligation may be a safe treatment for infected femoral artery pseudoaneurysms which need more clinical data to verify.