显微外科治疗四肢主要血管损伤的疗效分析

目的探讨应用显微外科技术治疗四肢主要血管损伤的临床效果。方法 2005年3月—2009年12月,收治47例四肢主要血管损伤患者,开放性损伤33例,闭合性损伤14例。动脉损伤部位：锁骨下动脉1例,股动脉16例,腘动脉11例,尺桡动脉同时损伤6例,肱动脉8例,腋动脉4例,胫前后动脉同时损伤1例。伤后至入院时间0.5～4h。应用显微外科技术直接修补6例,端端吻合24例,自体大隐静脉移植修复17例,移植长度3～10cm。结果 47例肢体成活,43例获6个月～4年随访,彩色多普勒血流仪检查血流速度及血管口径与健侧无明显差异。38例肢体功能恢复满意,5例残留不同程度功能障碍,其中3例行矫形或功能重建手术,功能及外形得到改善。结论对四肢主要血管损伤应争取早期诊断、早期及时应用显微外科技术修复,可收到良好的治疗效果。

THERAPEUTIC ANALYSIS OF MAJOR LIMB VASCULAR INJURIES WITH MICROSURGICAL OPERATION

Objective To investigate the clinical effects of treatment of major limb vascular injuries with microsurgical operation.Methods From March 2005 to December 2009,47 patients with vascular injury in limbs were treated.There were 34 cases of open injury and 14 cases of closed injury.The locations were subclavian artery in 1,femoral artery in 16,popliteal artery in 11,radial artery and ulna artery in 6,brachial artery in 8,axillary artery in 4 and anterior and posterior tibia artery in 1.The disease course was 30 minutes to 4 hours.Injured arteries were repaired by suturing directly in 6 cases,end-end anastomosis in 24 cases ,saphenous transplantation in 17 cases.The length of transplant veins was 3 cm to 10 cm.Results All the Limbs survived,Forty-three cases were followed up 6 months to 4 years.The blood flow rate and the diameter of blood vessel on the affected limbs were not different from that of normal limbs by colorful Doppler blood flow monitor.38 cases recovered satisfactory limb function.5 cases had different degrees of dysfunction,3 cases of which received functional reconstructive operation,function and appearance were improved.Conclusion The major limb vascular injuries should seek early diagnosis and timely microsurgical repair to ensure good treatment outcome.