111例血管损伤的诊治体会

回顾分析10年间我院收治的血管损伤病例的病因、临床表现和经验。方法和结果:111例(12～55岁)血管损伤的原因有钝性损伤、刀刺伤、枪弹伤。下肢50例,上肢36例,颈部13例,腹部12例。67例(60％)合并有骨和周围神经损伤。20例(18％,四肢17例,腹部3例)行血管造影和超声多普勒检查。17例(15％)在清创手术时未发现血管损伤,日后形成假性动脉瘤,4例伤后形成动-静脉瘘而再度就诊。动脉损伤的治疗:侧壁修补43例,损伤段动脉切除吻合25例,自体静脉移植8例,人工血管移植5例和动脉结扎1例。静脉损伤治疗:侧壁修补10例,损伤段静脉切除吻合6例,静脉补片1例,静脉结扎2例及非手术治疗1例,腹主动脉和腔静脉损伤者死亡3例(3％)。四肢血管损伤肢体存活率为97％。结论:手术探察是目前急诊诊断血管损伤的主要方法;术前血管造影检查对血管损伤的诊断具有决定意义;术式选择和合并脏器损伤的处理应根据伤情而定。

Experience in the Diagnosis and Treatment of 111 Cases of Vascular Injury

To review retrospectively the etiology, clinical presentation, diagnosis and manage-ment of vascular injury in the patients admitted during a 10-year period. Method and Results: 111 pa-tients with vascular injury were admitted to our hospital from 1988 to 1998. The injuries were caused by blunt trauma, stab wound or gunshot wound. The lower extremities were most commonly affected (50), followed by upper extremities(36), neck(13) and trunk(12); 67 cases(60%) had associated injuries of bone and peripheral nerves. Twenty cases(18%) underwent preoperative angiography, while 74 cases (67%) went to surgery without angiography because of severe ischemia or hemorrhage. Among the ca-ses explored and found negative, 17 were re-admitted for pseudoaneurysm and 4 for arterio-venous fi-stula. Arterial injuries were managed by primary repair in 43 cases, resection and followed by ana-stomosis in 25, autovenous grafting in 8, synthetic prosthesis interposition in 5 and arterial ligation in 1. Venous injuries were treated by primary repair in 10 cases, resection followed by anastomosis in 6, patch in 1, ligation in 2 and nonoperative management in 1. The limb salvage rate was 97%. Conclu-sions: Operative exploration was the main way to diagnose vascular injury under emergency setting; pre-operative angiography was helpful in establishing the diagnosis; the choice of operative procedure(s) depends on the complexity of the injury.