四肢血管损伤的手术治疗

目的　探讨四肢血管损伤修复手术对保存肢体的重要性及有效解除影响肢体存活的因素。方法　对1993年～ 2 0 0 0年收治 4 2例 5 8条四肢血管损伤分析其疗效及影响肢体存活因素。男 37例 ,女 5例。年龄 12～ 70岁。伤后手术时间 1小时～ 4 5天。急诊手术 38例 ,择期手术 4例。血管完全断裂 2 2例 32条 ;部分断裂 (撕裂 ) 5例 6条 ;血管缺损 15例 2 0条 ,缺损长度 5～ 10 cm。手术行血管端端吻合 2 2例 ,端侧吻合 1例 ,修补 5例 ,血管移植 14例 ,其中人造血管1例 ,长度 5 cm。结果　急诊手术者 ,手术成功 35例 ,截肢 3例 ;术后发生血管危象 5例 ,血肿形成及假性动脉瘤各 1例。择期手术 4例均成功 ;术后发生血管危象 1例。术后随访 6个月～ 7年 ,除 3例截肢外 ,7例断肢再植术后肢体功能恢复差 ,余血管修复术后肢体功能恢复满意。结论　尽快修复受损血管 ,及时处理血管危象及解决影响肢体存活因素是保存肢体及恢复功能的关键。

SURGICAL MANAGEMENT OF VASCULAR INJURY OF EXTREMITIES

Objective To summarize the importance of surgical management to repair vascular injury in limbs salvage, and to analyze the influence factors in the management. Methods From 1993 to 2000, 42 cases of 58 vascular injuries were reviewed; there were 37 males and 5 females, aging from 12 to 70 years old. Emergency operations were performed in 38 cases and selective operations in 4 cases from 1 hour to 45 days after injury. There were 22 cases of complete rupture in 32 blood vessels, 5 cases of partial rupture in 6 blood vessels, and 15 cases of vascular defect in 20 blood vessels, with 5 cm to 10 cm defect. The operation management included end to end anastomosis in 22 cases, side to end anastomosis in 1 case, vascular repair in 5 cases and vascular grafting in 14 cases. All of the cases were followed up for 6 months to 7 years. Results In those received emergency operations, it was successful in 35 cases, with amputation in the other 3 cases; after operation, there were 5 cases of post operative angio crisis, 1 case of hematoma and 1 case of pseudoaneurysm. In those received selective operation, all succeeded but 1 case of post operative angio crisis. After the follow up, except for 3 cases of amputation, the other limbs survived; and function of the survived limbs recovered satisfactorily after operation except poor recovery in 7 cases of replantation of the limbs. Conclusion To repair vascular injury immediately, to manage angio crisis and to remove influence factors is the key to save the injured limbs and to maintain the function of them.