21例感染性四肢主要动脉损伤的救治

Surgical treatment of the infected major artery injuries in extremities

目的 探讨感染性四肢主要动脉损伤的有效救治方法。方法对 2 1例四肢主要动脉损伤病例 ,在对感染区彻底清创引流后 ,根据病情 ,分别行自体血管旁路血管重建、单纯血管结扎或截肢术 ,9例肌皮瓣转位覆盖创面 ,将移植物置于较健康的区域。结果 本组死亡 1例 (1 / 2 1 ,4 .8% ) ,截肢 5例 (5 / 2 1 ,2 3.8% ) ,1 5例 (1 5 / 2 1 ,71 .4 % )以旁路自体静脉移植成功修复 ,其中 1 4例 (1 4 / 1 5 ,93.3% )Ⅰ期血管通畅、1例 (1 / 1 5 ,6 .7% )血栓形成 ,Ⅱ期再行自体静脉移植成功。结论 彻底清创后 ,行旁路自体静脉移植和肌皮瓣转位是感染性四肢主要动脉损伤的较有效的治疗方法。

Objective To research the effective treatment of the infected major artery injuries in extremities.?Methods According to 21 patients’ condition,amputation,blood vessel ligation and extra anatomic bypass artery reconstruction by autologous vein were selected respectively.?New grafts were placed in a clean bed.?Local flap displacement was used in 9 cases.?Results One case (1/21,4.8%) died during the treatment.?Five cases ( 5/21 ,23.8%) underwent amputation.?Fifteen cases (15/21,71.4 %) were reconstructed successfully.?The early patency rate was 93.3%(14/15),thrombosis occurred in 1 case (1/15,6.7 %)and good result was obtained after the second operation.?Conclusion Debridement of the infected tissue and the reconstruction by extra anatomical autologous vein bypass are effective in treatment of vascular injuries with infection in extremities.