火器性四肢动脉伤(附50例报告)

Gun-shot Wounds of the Extremities with Major Arterial Injuries: A Report of 50 Cases.

作者报告５０例５２条四肢火器性动脉伤，其中枪弹伤３７例，弹片伤１３例；急性动脉伤３２例（３３条），晚期动脉伤８例，假性动脉瘤７例，动静脉瘘３例（４条）。平均随访２４．２个月，无一例死亡，修复血管通畅率９３％，截肢率９．８％，肢体缺血性挛缩发生率１０．９％。作者强调，早期诊断、早期正确处理此类动脉伤是成功的关键。应争取在伤后６～１２小时内修复损伤血管。根据临床表现可作出诊断，急性动脉伤一般不做血管造影，对可疑肢体主要动脉伤应积极手术探查。根据伤情采用对端吻合或自体静脉移植修复血管，不主张用人造血管修复，血管部分断裂不宜做侧壁吻合。晚期动脉伤应争取修复血管以改善肢体循环。假性动脉瘤和动静脉瘘宜早期切除修复血管，待伤口愈合、组织柔软后即可手术。

Fifty cases (52 vessels) of gun shot wound of the extremities with major arterial injuries were reviewed. There were 37 gun bullet injuries, and 13 shell fragment injuries. Thirty two cases were classified as acute injury, 8 chronic injury , 7 pseudoaneurysms and 3 arteriovenous fistulae. The mean follow up period was 24.2 months and there was no death. The patency rate of the repaired vessels was 93%, the amputation rate was 9.8% and limb ischemic contracture occurred in 10.9%. The authors stressed that, early diagnosis and management according to the clinical manifestation were the key to a successful outcome. Generally, angiography is not chosen as the primary routine examination method. Open exploration is necessary when major arterial damage is suspected. End to end anastomosis or autogenous venous graft should be the choice according to the extent of the injury. The authors advocate that the vascular prosthesis is not suitable to bridge the gun shot injured arteries. To repair the partial vascular injury, a lateral suture is not appropriate. Late arterial injury with serious ischemic symptom should be repaired to improve the circulation of the extremities. In the management of pseudoaneurysms and arteriovenous fistulae, excision of the lesion and restoration of vascular continuity should be performed after complete healing of the soft tissues wounds.