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周围血管损伤的外科治疗

APPLICATION OF CROTCH-SHAPED VEIN GRAFTS IN REPAIRING DEFECTS OF THEVESSELS WITH A LARGE DIAMETER

Objective To investigate the results and applicationvalue of crotch-shaped vein grafts in repairing defects of the vessels with a large diameter.Methods From June 1998 to October 2003, 35 cases of vesseldefects with a large diameter were repaired with crotch-shaped vein graft (29 males and 6 females,aged 18 to 45 years with an average of 25.7 years ). The locations of defects were femoral artery in 25 cases, popliteal artery in 2 cases, femoral vein in 7 cases, and subclavian vein in 1 case. The interval between injure and operatioinwas 1-8.5 hours (4.1 hours on average).The blood flows of trouble and healthy vascular were determined with Doppler detector and compared preoperatively andpostoperatively. Results All the anastomotic stomas were patent in 35 cases. Thirty-one cases were followed up 6 weeks to 24 months (9.5 months on average), the patent rate was 100%, no case occurred vasospasm or tromboembolism; 2 cases occurred stomal leak and became hematoma, 3 cases occurred muscular necrosis, and the 5 cases achieved primary healing after secondary operation. The Doppler results showed that there was statistically significant difference in the blood flow betweenpostoperation and preoperation (Plt;0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular (Pgt;0.05). Conclusion The methodof crotch-shaped vein grafts is safe and effective in repairing defects of vessels with a large diameter,which is easy to draw materials and handy to operate. It has a promising value in clinical application.

介入辅助外科手术治疗闭合性四肢血管损伤

目的 探讨介入辅助外科手术在闭合性四肢血管损伤的方法和疗效。方法 1989年8月~2004年4月，应用介入辅助外科手术治疗闭合性四肢血管损伤16例。男12例，女4例；年龄13～57岁。血管损伤部位：腋动脉2例，旋肱前动脉1例，旋肱后动脉4例，肩胛下动脉1例，肱动脉2例，髂动脉1例，股动脉4例，动脉1例。合并颅脑损伤3例，内脏损伤2例，神经损伤2例，骨折脱位8例。血管完全断裂13例，部分断裂2例，血管痉挛1例。9例有血管缺损，缺损范围4～8cm，平均5.8 cm。受伤至就诊时间1～3 h，平均1.5 h。介入手术时间 20～40 min，平均 28 min；血管修复手术时间1～3.5 h，平均1.7 h。结果 术后16例血管损伤肢体均无坏死。2例腋动脉损伤及3例股动脉损伤患者，术后3个月造影复查，血管均通畅。合并骨折者术后16～42周骨折愈合，平均26周。经2~13年随访，1例合并臂丛神经损伤者术后肩关节功能恢复差，余患者功能均满意。结论 介入辅助外科手术能够准确确定闭合性血管损伤的位置，减少手术盲目性，缩短手术时间，减少出血，提高了血管修复的成功率，是治疗闭合性四肢血管损伤的一种有效方法。

Progress of Non-Invasive Arterial Measurements and Evaulation of Cardiovascular Injury of OSAHS

阻塞性睡眠呼吸暂停低通气综合征( OSAHS) 是心血管疾病的独立危险因素[1,2 ]。睡眠过程中反复发生氧饱和度降低和频繁觉醒是心血管损伤的病理生理基础。OSAHS 血管损害的早期改变可表现为血管僵硬度增加, 对亚临床血管病变患者开展早期动脉弹性功能检测及早进行干预, 可有效预防心血管疾病的发生。本文就常用的无创动脉硬化检测lt;br /gt;技术及其对OSAHS 心血管损伤的评估相关研究进展进行综述。

REPAIR OF DEFECTS AT BOTH ENDS OF BLOOD VESSELS IN EXTREMITIES WITH AGREAT DISPARITY IN DIAMETER BY VEIN TRANSPLANTATION

Objective To repair defects at both ends of theblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities by phleboplasty of branched and double autogenous veins. Methods Three kinds of phleboplasties——funnel-shaped, raincape-shaped and transposed Y-shaped were designed. Experiments in fresh blood vessels in vitro were completed successfully. These methods were used clinically to repair injured external iliac veins, femoral arteries and veins, and popliteal arteries and veins, to replant severed fingers and to transplant toenail flaps on thumbs by harvesting autogenous great saphenous veins,small saphenous veins and forearm veins in 36 cases, including 35 cases in emergency operation and 1 case in selective operation.The length of grafted blood vessels ranged from 1.0 cm to 15.0 cm. Results The phleboplasties of funnel-shaped could enlarge the diameter by 1.0-1.25 times inanastomotic stomas. The phleboplasty of raincape-shaped could enlarge the diameter large enough to meet the demands for various blood vessels in extremities. The phleboplasty of transposed Y-shaped could provide large vein transplants. In36 grafted veins, 35 were in patency. The blood supply in extremities was normal.ConclusionThe funnel-shaped and raincape-shaped phleboplasties of branched veins can enlarge the anastomotic stomas of grafted veins. The transposed Y-shaped phleboplasty of double femoral veins is an ideal way to repair injured primaryblood vessels with a considerable disparity in the diameter of the both sides or with a large diameter in extremities.

ADVANCES IN THE DIAGNOSIS AND TREATMENT OF ACUTE VASCULAR INJURIES

创伤性浮膝合并血管损伤的治疗

目的 总结创伤性浮膝合并血管损伤的手术方法及疗效。 方法 2001 年3 月－ 2008 年3 月收治23 例创伤性浮膝合并血管损伤。男14 例，女9 例；年龄21 ～ 63 岁。车祸伤15 例，高处坠落伤5 例，重物砸伤3 例。开放骨折16 例，按照Gustilo 分型：Ⅰ型8 例，Ⅱ型6 例，Ⅲ型2 例。血管损伤类型：横行断裂12 例，纵行裂伤4 例，挫伤缺损4 例，内膜损伤栓塞3 例。受伤至入院时间为30 min ～ 4 h，平均2 h。采用小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管。 结果 骨折均获解剖复位。术后外固定针道感染3 例。4 例于术后7 ～ 10 d 出现切口浅表感染，其余切口均Ⅰ期愈合。1 例于术后12 d 因缺血坏死、感染行截肢术，余22 例保全肢体。22 例术后获随访，随访时间14 ～ 38 个月，平均18.5 个月。骨折均愈合，愈合时间为15 ～ 24 周。术后1 年肢体功能按Karlstrouml;m 等评价标准，优10 例，良8 例，中3 例，差1 例。 结论 小切口复位股骨逆行交锁髓内钉联合胫骨外固定器固定，同时修复血管，是治疗创伤性浮膝合并血管损伤的一种较好选择。

四肢主要血管火器伤的修复重建

对40 例四肢主要血管火器伤患者的临床资料进行回顾性分析，总结损伤的有效救治方法。 方 法 1986 年5 月－ 2006 年11 月，收治40 例四肢主要血管火器伤患者。男35 例，女5 例；年龄16 ～ 50 岁，平均31. 2 岁。动脉完全断裂16 例，动脉部分断裂6 例，动脉缺损14 例，动脉血栓形成2 例，假性动脉瘤2 例。病程12 min ～ 20 h。彻底清创、充分减压和引流，根据不同情况选择自体静脉移植25 例，人造血管移植3 例，血管吻合6 例，血管修补4 例，带血管蒂的轴型皮瓣游离移植2 例。 结果 经抗感染、输血补液及抗凝、扩张血管等治疗，死亡1 例，截肢2 例，肾衰竭截肢1 例，成功修复36 例。伤口Ⅰ期愈合29 例，Ⅱ期愈合7 例。经7 个月～ 2 年随访，修复血管均恢复通血，肢端血运良好，动脉搏动正常，按英国医学会感觉运动功能评定标准：优28 例，良6 例，差2 例。 结论 “生命第一、肢体第二”是四肢主要血管火器伤的救治原则，采用自体静脉或人造血管旁路移植修复可获良好效果。

无骨折指体血管损伤的修复

目的 探讨无指骨骨折指体血管损伤后的临床处理及效果。 方法 1998年10月～2005年12月，根据指体血管损伤的程度，分别对56例62指采用直接修复血管神经肌腱、截骨短缩指骨、移植血管加腹部皮瓣移位三种方法进行修复。其中男38例42指，女18例20指；年龄18～40岁，平均29岁。皮带卷轧伤18例，纺纱卷伤16例，绳子勒伤16例，其他6例。拇指12指，食指18指，中指16指，环指10指，小指6指。术后按断指再植的术后处理，移位皮瓣修复者患侧肢体与躯干用绑带捆绑固定，注意观察皮瓣有无扭转。结果 采用直接吻合血管和截骨短缩指骨修复的44例50指，成活49指，成活率98％；采用移植血管加腹部皮瓣移位修复的12例12指，指体皮瓣均成活。成活的61指经6~12个月随访，根据断指再植评定标准，优35指，良15指，差8指，劣3指，优良率82％。结论 对无指骨骨折指体血管损伤，应根据血管损伤程度采用不同方法修复，能保留指体及恢复功能。

闭合性腘动脉损伤显微外科治疗