血管吻合术后晚期突发危象的处理

Management of delayed vascular crisis

目的探讨血管吻合术后晚期突发危象的处理方法。方法对2008年12月至2014年11月31例在血管吻合术3d后突然出现血管危象并进行手术探查的病例资料进行回顾性分析。其中再植22例，足趾移植5例，游离皮瓣移植4例。探查时间最短的是术后3d，最长的是术后10d。结果探查再植和再造的27例均为动脉危象，4例游离皮瓣均有静脉危象，2例伴有动脉危象。再植22例中坏死7例，成活率68％；再造5例全部存活，成活率100％；皮瓣移植4例中完全坏死1例，边缘1／3坏死1例，成活率63％。回顾发现31例D-二聚体的检测值在术后均高于正常。结论血管吻合术后出现晚期血管危象，只要组织尚未变性，尽早手术探查可获得良好的治疗效果。对D-二聚体值偏高的患者严密观察，必要时延长使用肝素钠时问。

Objective To discuss the treatment strategies for delayed vascular crisis in vascular anastomosis cases. Methods Clinical data of 31 cases of vascular crisis detected 3 days after vascular anastomosis and treated with surgical exploration from December 2008 to November 2014 were analyzed. There were 22 cases of replantation, 5 cases of toe transplantation, and 4 cases of free flap transplantation. The shortest detected time was 3 days postoperatively, and the longest 10 days postoperatively. Results Arterial crisis was identified in all 27 cases of replantation and transplantation. In the free flap cases, venous crisis occurred in all 4 cases with accompanying arterial crisis in 2 cases. Among the 22 replants, 15 survived while 7 were lost to necrosis, the survived rate being 68%. Surgical exploration and revision salvaged the toe transplant in all 5 cases, the survival rate being 100%. Of the 4 flap transplantation cases, total flap necrosis occurred in 1 case and 1/3 edge necrosis occurred in another, the survival rate being 63%. The value of D-dimer was higher than normal in all 31 cases. Conclusion In the event of delayed vascular crisis after vascular anastomosis, early and active exploration before tissue deterioration was crucial for survival. For patients with high values of D-dimer, vigilant observation and prolonged administration of heparin are necessary.