四肢主干动脉损伤的治疗分析

Treatment Analysis of the Major Arterial Injuries in Limbs

目的：探讨四肢主干动脉损伤的有效治疗方法。方法：回顾性分析2007年1月～2012年1月47例四肢主干动脉损伤患者的治疗临床资料。外科手术42例，其中单纯动脉破裂修补术11例，直接吻合11例，大隐静脉移植术17例，人工血管移植术3例；另外5例行腔内治疗，其中覆膜支架植入3例，裸支架植入2例。结果：44例肢体成活，截肢3例。40例患者获门诊随访，为35例手术患者和5例腔内治疗病例，截肢患者均未随访。随访时间为3个月一3a，平均随访时间15个月。在接受随访的35例手术患者中有5例吻合口处血管轻度狭窄，3例移植血管内重度狭窄，l例移植血管内闭塞；腔内治疗5例无明显异常发现。结论：外科手术及腔内治疗是四肢主干动脉损伤的有效治疗方法；选择合适的治疗方法，早期诊断和治疗，是保全肢体的关键。

Objective： To explore the effective therapeutic method of the major arterial injuries in limbs. Methods ：The clinical data of 47 cases with the main arterial injuries in limbs treated in our department from January 2007 to January 2012 were retrospectively analyzed. 42 cases were treated with surgery, including 11 cases with the simple artery rupture repair, 11 cases with artery direct anastomosis, 17 cases with great saphenous vein grafting and 3 cases with artificial blood vessels grafting, and the other 5 cases were treated with intracavitary therapy including stent implanted in 3 cases, and bare stent implantation in 2 cases. Results：44 limbs were survived, and 3 limbs were amputated. 40 cases were followed up in our outpatient service, including 35 cases surgical patients and 5 cases treated with intracavitary therapy, with the follow up time for 3 months to 3 years; an average followup time was 15 months. Amputees were not followed up. Mild stenosis occurred in 5 operation cases, which happened at the site of anastomosis. Severe transplant intravascular artery stenosis occurred in three cases and occlusion in grafting vessels occurred in 1 case. The other 5 cases with en dovascular treatment were normal. Conclusions：Surgical procedures and intracavitary therapy are effective ther apeutic methods for patients with the main arterial injuries in limbs. The key point to assure the safety of hmbs is earlier diagnosis and treatment with suitable therapeutic method.