裤裆式静脉移植在修复四肢大血管损伤中的应用

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

目的 探讨“裤裆式”静脉移植修复大血管损伤的效果及临床应用价值。 方法 1998年6月～2 0 0 3年10月,采用“裤裆式”静脉移植修复治疗大血管损伤患者35例(男2 9例,女6例) ,年龄18～4 5岁。其中股动脉损伤2 5例,动脉损伤2例,股静脉损伤7例,锁骨下静脉损伤1例。受伤至手术时间1～8.5 h,平均4 .1h。术前、术后均应用多普勒血流探测仪探测患侧及健侧血管的血流速度,并进行比较。 结果 35例术中血管即时通畅率为10 0 %。其中31例获6周～2 4个月随访,血管通畅率10 0 % ,无血管危象发生;2例出现吻合口瘘致血肿形成,再次手术后无复发;2例因肌肉挫伤严重,1例因急救压迫止血时间偏长而发生部分肌肉坏死,经二期扩创后治愈。多普勒血流探测仪探测患侧术后血流速度与术前比较,差异有统计学意义(P<0 .0 1) ;与健侧比较差异无统计学意义(P>0 .0 5 )。 结论 “裤裆式”静脉移植是修复大血管损伤的有效方法之一,其取材容易、操作简便,具有较高的临床应用价值。

Objective To investigate the results and application value 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 vessel defects 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 operatioin was 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 and postoperatively. 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 between postoperation and preoperation ( P <0.01), but no statistically significant difference when compared the trouble vascular after operation with healthy vascular ( P >0.05). Conclusion The method of 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.