兔股动脉火器伤海水浸泡后的外科处理及其疗效

Surgical management and its therapeutic effect of gunshot wounded femoral arteries immered in seawater in rabbits

目的 探讨血管火器伤海水浸泡后的外科处理方法。方法 将 1 0 0只白兔用 0 .38g钢珠弹致单侧股动脉伤后 ,分为海水浸泡组 (动物置于人工海水中浸泡 6 0min)和单一致伤组 (不浸泡 )。两组均切除动脉肉眼观损伤段 ,用直接端 端吻合、自体静脉或低温保存的同种异体动脉移植进行重建。术后 2 4h ,7、1 4、2 1d用多普勒超声监测血流通畅情况 ,对部分通畅和全部不通畅者行手术探查 ,取吻合口组织做光、电镜检查。结果 动脉完全断裂伤 :海水浸泡组和单一致伤组的 3周累计通畅率分别 80 .0 0 %和86 .6 7% ,两组间差异不显著 (P >0 .0 5 ) ;动脉挫伤 :海水浸泡组和单一致伤组的 3周累计通畅率分别为 86 .6 7%和 82 .35 % ,两组间差异不显著 (P >0 .0 5 )。两组均为术后 1周内发生血栓最多 ,1周后趋于稳定。两组均见术后 1周时吻合口附近有内皮细胞增生 ,术后 3周内皮化过程基本完成。结论 血管火器伤合并海水浸泡的外科处理中 ,仅切除肉眼观损伤段血管后用常规方法进行重建可获得满意的早期疗效 。

Objective To investigate the surgical management of a gun shot wound of blood vessels and immersied, and evaluate its primary effect. Methods 100 rabbits were divided randomly into simple wounded group(SWG, n =50) and seawater immersion group(SIG, n =50).Femoral arteries were impacted by 0.38 gram steel spheres with velocity of 600～800 meters per second fired by 7.62 mm rifle. Animals in SIG were immersed in artificial seawater (pH 8.2～8.4, salinity 25.4,temperature 21℃) for 60 min, of which those in SWG were spared. Grossly injuried artery was excised and restoration of blood flow was reconstructed by end to end anastomosis or reversed autogenous venous grafting or cryopreserved arterial allografting. At 24 h,7,14,21 days after operation, blood flow was examined by Doppler ultrasonic detection and part of anastomotic sites and graft were collected for pathological observation. Results In completely transected injury, the patency in SIG was 80.00%,while that in SWG was 86.67% in the first 3 weeks. In arterial contused injury ,patency in SIG was 86.67%,and that in SWG was 82.35% at the same time. Thrombosis occurred mostly in the first postoperative week. Atypical endothelial cells were found at the anastomosis sites in the first postoperative week, and the anastomosis sites were lined with endothelium in 3 weeks postoperatively. Conclusion Early curative effect could be obtained. When grossly injuried artery is excised and followed by a routine surgical procedure in the treating gunshot wounds immersed in seawater.