吻合血管术后迟发性血管危象原因与对策

The cause and strategy of delayed vascular crisis after blood vessel anastomoses

目的探讨吻合血管术后发生迟发性血管危象的原因并找出对策。方法统计2001年9月至2004年3月间94例吻合血管手术,21例于术后7～13d发生血管危象,在常规处理血管危象的基础上,结合发生血管危象的组织或指体的伤口,若有感染,则放弃手术探查,采用加强抗感染治疗。伤口无感染且未能缓解者,予手术探查。结果21例迟发性血管危象存活16例,失败5例。其中非手术治疗16例,13例成功,3例失败而手术探查5例,3例成功,2例失败。结论迟发性血管危象与术后感染有极大的关系,彻底的清创,可避免感染的发生,从而最大限度控制迟发性血管危象的发生。

Objective To explore the cause of delayed vascular crisis after vascular anastomosis,and put forward the strategy. Methods Twenty-one cases of vascular crisis were detected 7 to 13 days after operation in 94 cases of vascular anastomoses in different microsurgical surgeries. On the base of routine treatment, evaluate the wound of these cases of vascular crisis, if it was infected, give up operation, strengthen the anti-infectious treatment. If the wound was not infected and vascular crisis was not relieved, carry on operation. Results Sixteen cases were survival in these 21 cases of delayed vascular crisis,and 5 cases failure. Sixteen cases were treated by conservative methods with 13 cases success and 3 cases failure. The others 5 cases were treated by operations with 3 cases success and 2 cases failure. Conclusion Delayed vascular crisis is closely related to the infection after operation. The thorough debridement can avoid the infection,so as to maximum control the delay vascular crisis.