吻合血管术后55例血管危象探查体会

The experience of exploration of vascular crisis after 55 cases of vascular anastomosis

目的对吻合血管术后55例（63次）血管危象进行临床分析。方法对2004年4月至2007年12月在我院手外科有完整资料的55例（63次）发生血管危象的病例资料进行回顾性分析，其中断指再植29例、足趾移植手指再造17例、游离皮瓣8例、手指不全离断1例。所有病例均经保守治疗1h后血管危象无缓解而进行手术探查，根据术中所见血管情况进行相应处理，其中26例30次动脉栓塞、17例20次动脉痉挛、10例11次静脉栓塞、2例2次血管受压；其中包括动脉张力过低1例、静脉张力过高1例、动脉分支未结扎1例。根据术中所见，20例23次行前臂浅静脉血管移植，33例38次行栓塞段血管切除重新吻合，1例修剪压迫组织，1例清除局部血肿。结果本组55例，存活51例，成活率92．73％。其中坏死的有断指再植2例，足趾移植手指再造1例，游离皮瓣1例。结论血管吻合术后一旦发生血管危象，经保守治疗无效后，早期、积极地手术探查是挽救的关键措施。

Objective To conduct clinical analysis of 55 eases （63 incidents） of vascular crisis after vascular anastomosis. Methods Fifty-five cases （63 incidents） of vascular crisis treated in the Department of Hand Surgery in our hospital from April 21304 to December 2007 with complete data were retrospectively reviewed. There were 29 cases of finger replantafion, 17 cases of toe-to-finger transfer, 8 cases of free flaps, and 1 ease of incomplete finger amputation. All the eases of vascular crisis underwent surgical exploration after one hour conservative treatment failed to relieve the crisis. Intmoperative findings revealed the following vascular conditions： 26 cases （30 incidents） of arterial embolization, 17 cases （20 incidents） of artery spasm, 10 cases （11 incidents） of vein thrombosis, 2 cases （2 incidents） of vascular compression, 1 case of too low arterial tension, 1 eases of too high venouss tension, and 1 ease of arterial branches not being ligated. According to the intraopemtive findings, forearm superficial vein grafting was done in 20 cases （23 incidents）, resection of the embolised segment and vascular re-anastomosis was done in 33 eases （38 incidents）, while removal of the tissue that compressed the vessel was done in one eases and local hematoma removal was carried out in another case. Results Among the 55 cases, 51 cases survived. The survival rate was 92.73%. Tissue necrosis and subsequent failure occurred in 2 eases of finger replantation, 1 ease of toe-to-finger transfer, and 1 case of free flap. Conclusion In the event of vascular crisis after vascular anastomosis, once the oonservative treatment proved ineffective, early and active surgical exploration was crucial for salvage and survival.