断指再植术后动脉危象的处理

Management of arterial crisis after finger replantation

目的 介绍断指再植术后动脉危象的处理。方法 4 6例 ( 4 6指 )断指再植在术后 6～ 72小时内出现动脉危象 ,经采用罂粟碱 3 0 mg肌肉注射等保守治疗 1小时后 ,动脉危象仍未解除。即行手术探查 ,发现动脉吻合口血管内膜损伤或缺损 2 8例 ,血管吻合技术差 11例 ,血管远端分支未结扎 2例 ;动脉痉挛 5例。血管均严重痉挛、变细、无血液通过吻合口。机械解除动脉痉挛 5例 ;动脉栓塞 4 1例 ,切除吻合口后动脉直接吻合 6例 ,静脉移植 3 5例。结果 4 6指成活 4 3指 ,成活率为 93 .5 %。结论 精细的显微外科技术是断指再植获得成功的关键 ,正确判断动脉危象 ,及时手术探查是提高该类断肢再植成活率的有效手段。

Objective To introduce the methods for management of arterial crisis after finger replantation. Methods 46 cases of finger replantation with postoperative arterial crisis were reviewed. The circulation crisis happened 6 to 72 hours after the replantation. Surgical exploration was carried out in these cases because the conservative management using intramuscular injection of 30 mg Papaverine failed to release the crisis. The exploration revealed trauma or defect of the intima of the arteries at the anastomotic sites in 28 cases, poor quality anastomosis in 11 cases, leakage of the distal branches in 2 cases, and arterial spasm in 5 cases. Vasospasm of the 5 cases was corrected by mechanical expansion. Thrombosis was found in the rest 41 cases. The anastomotic site of the arteries was resected and the thrombi milked out. The arteries were than reanastomosed with direct suture in 6 cases and with venous graft in 35 cases. Results Of the 46 fingers with second surgical exploration, 43 fingers survived, the surviving rate being 93 5 %. Conclusions Meticulous microsurgical technique is key to the success of finger replantation. Prompt surgical exploration in case of irreversible arterial crisis can salvage the replanted fingers