超时限四肢主要血管损伤的救治

Treatment of main vascular injuries exceeding 12 hours in the extremities: a report of 19 cases

目的探讨超过12 h的四肢主要血管损伤的治疗对策和疗效. 方法自1989年至2003年共收治再通血时间超过12 h的患者19例.血流中断时间最短12.6 h,最长超过37 d,平均42 h.采用血管直接端对端吻合2例;损伤血管段切除,自体静脉移植9例;人造血管移植1例;血管热敷,外膜注射罂粟碱解除痉挛1例.明确坏死者则直接截肢. 结果本组无一例死亡.直接截肢6例;4例血管修复术后并发肾功能衰竭,于修复后1～3 d截肢;1例术后发生肢体顽固性感染,4周后截肢.保存肢体的8例患者中,伤口Ⅰ期愈合4例,其余4例伤口皮肤、肌肉部分坏死,经过换药植皮,伤口愈合,但遗留不同程度缺血性肌挛缩. 结论超时限的血管损伤,部分可经血管修复手术而避免截肢,但遗留不同程度功能障碍.

Objective To review the management and outcomes of patients with main vascular injuries in the extremities, where the time between injury and treatment is over 12 hours. Methods From 1989 to 2003, 19 patients with main vascular injuries in the extremities in which the time between injury and treatment was over 12 hours (from 12.6 hours to 37 days, average 42 hours) were admitted. Thirteen patients were treated by vascular repair including direct anastomosis in two cases, autogenous vein graft in nine, synthetic graft in one and antispasmodic subadventitia injection with local fomentation in one. Results There were no deaths. Primary amputation was carried out in six cases. Of the patients treated by vascular repair, amputation was performed in four secondly after 1-3 days due to acute renal failure and in one after four weeks due to intractable infection. The wounds were healed primarily in four patients and secondly in other four who had various degrees of ischemic myospasm. Conclusion Part of main vascular injuries in the extremities exceeding 12 hours can be treated by vascular repair that may avoid amputation but leave different degrees of functional drawbacks.