锁骨下动脉损伤的外科处理

目的 探讨锁骨下动脉损伤的外科治疗特点。方法 1990年7月～2006年1月，对12例锁骨下动脉损伤患者，取锁骨上下联合切口，充分显露锁骨下动脉全段，分别采用动脉破口修补、包裹修复、血管吻合及人造血管移植修复重建损伤动脉。均为男性，年龄18～36岁，平均22.6岁。损伤部位：锁骨下动脉第1段1例，第2段4例，第3段7例。损伤类型：均为不完全断裂及破损，其中动脉破损区小于动脉周径1／3者4例，小于动脉周径2／3者5例，大于动脉周径2／3者3例。伴全臂丛神经损伤1例，神经干缺损5cm；部分臂丛神经损伤3例，其中2例仅前束损伤，神经缺损分别为4cm和6cm；正中神经完全损伤及尺神经不完全损伤1例，神经缺损4cm。损伤至手术时间3h～1.5个月。结果 术后无死亡及肢体坏死。获随访2个月～12年，平均5年2个月。10例桡动脉搏动恢复良好，2例桡动脉搏动不明显，均为动脉直接吻合者。4例合并臂丛神经损伤患者，前束损伤者术后肢体功能基本恢复正常，屈肘肌力Ⅳ级；全臂丛神经完全损伤者术后上肢功能基本无改善。结论 锁骨下动脉解剖位置特殊，动脉损伤后显露、修复均较困难。锁骨上下联合切口可在直视下显露动脉全段，修复重建安全可靠。

SURGICAL TREATMENT OF TRAUMATIC SUBCLAVIAN ARTERY

Objective To explore the treatment of traumatic subclavian artery.Methods From July 1990 to January 2006,12 cases of traumatic subclavian artery were treated by using of combined incision of superior-inferior clavian.All patients were male,aging 18-36 years(mean 22.6 years).The locations were section 1 of subclavian artery in 1 case,section 2 in 4 cases and section 3 in 7 cases.All patients had incomplete rupture and defect.Time from injury to operation was 3 hours to 1.5 months.The methods of vascular repair included primary repair,end-to-end anastomosis and artificial vascular prosthesis grafts.Results There was no death.Extremities survived in all cases and got good function in 10 cases.All patients were followed up 2 months to 12 years(mean 5 yeras and 2 months).The pulse of radial artery restored to normal in 10 cases and did not be felt in 2 cases.The function of extremities restored to normal in 2 cases with partial injury of brachial plexus nerve and did not improve in 2 cases with complete injury of brachial plexus nerve.Conclusion The exposure of subclavian artery is difficult because of its particular anatomy region.The repair and reconstruction of subclavian artery should be selected according to the type of vascular injuries.Combined superior-inferior clavian approach can satisfy the exposure and repair for the subclavian artery.