无伴行动脉损伤的肢体静脉干损伤的修复

REPAIR OF VENOUS TRUNK INJURIES WITHOUT ACCOMPANIED ARTERIAL INJURIES IN EXTREMITIES

目的 探讨无伴行动脉损伤的肢体静脉干损伤的机制,以及诊断、救治和修复方法。 方法 1993年1月～2 0 0 2年6月共收治12例患者,均为男性,年龄18～35岁。受伤至手术时间30 min～2 h。均为锐器刺伤。在积极抗休克的同时进行血管修补7例,端端吻合5例。合并头颅胸腹部损伤患者同时给予相应手术处理。 结果 除1例患者因严重的脑外伤死亡外,余11例患者伤口均 期愈合。随访1～5年,平均2年4个月,彩色多普勒检查见血流通畅,无血栓形成。其中8例肢体功能和血循环恢复良好;3例合并伴行神经损伤者血循环恢复良好,但肢体功能恢复欠佳,遗留感觉及运动障碍。 结论 无伴行动脉损伤的肢体静脉干损伤是一种严重的损伤,采取应急止血、积极抗休克、及早修复损伤血管和合理处理合并伤等是挽救患者生命的重要措施。

Objective To research the mechanisms, diagnosis and repair method of venous trunk injuries without accompanied arterial injuries in extremities. Methods From January 1993 to June 2002, 12 cases of venous trunks injuries without accompanied arterial injuries in extremities were treated. All the patients were males, their ages ranged from18 to 35 years. The interval between injury and operation was 30 minutes to 2 hours. The cause of injury was stab wound. Along with the antishock, the injured vessels were mended in 7 cases, end-to-end anastomosis was performed in 5 cases, and the operations were given in the patients with red wounds of the skull, chest or abdomen. Results One case died of severe cerebral trauma, the other 11 cases obtained primary healing. Dopplersonograpy showed that the blood vessels were patent. After a follow-up of 1- 5 years(2 years and 4 months on average), 8 cases recovered the function and circulation of extremities; and 3 cases accompanied with red injuries of nerves recovered the circulation of extremities, but did not recover the function with sensory disability and dyskinesia. Conclusion Emergent hemostasis, antishock, repair of the injured vessels as soon as possible and treatment of associated injuries are important measures to save patients' life in treating venous trunk injuries without accompanied arterial injuries in extremities.