血管移植修复掌浅弓缺损的研究进展

Research progress on reconstruction of superficial palmar arch by vascular grafting

目的 探讨不同部位血管移植修复掌浅弓血管缺损的研究进展.方法 以＂vascular system injuries＂＂superficial palmar arch＂＂vascular grafting＂＂vein grafts＂＂arterial graft＂和＂血管系统损伤＂＂掌浅弓＂＂血管移植术＂＂静脉移植＂＂动脉移植＂作为关键词,限定语言种类为英文和中文,在PubMed、中国知网和万方数据库检索2016年12月之前发表的有关掌浅弓缺损后应用血管移植修复的相关文献,进行归纳总结.结果 临床上对于严重外伤所致的掌浅弓缺损,主要采用浅静脉移植和小动脉移植两种方式进行重建.不同的修复方式具有不同的优缺点：足部静脉移植多采用端侧吻合的方式,可提供足够多的吻合口,但手术操作难度较大;Y型静脉移植多将移植血管串联桥接,优点是远端可提供多个吻合端口,但手术繁复,桥接后的血管远近端口径与受区血管口径相差较大;前臂静脉网移植可以解决供受区血管不匹配难题,但血管网解剖不恒定,增加了手术切取难度;手背静脉弓形态、口径与掌浅弓相近,手术切取及吻合操作均较容易,而瓣膜阻挡及手背瘢痕明显是其缺点;足背浅静脉弓移植修复掌浅弓缺损,可以解决供受区远、近端血管口径不匹配、数目不等难题,但瓣膜阻挡血流一直是困扰着临床的难题;小动脉移植修复掌浅弓缺损,临床效果可靠,缺点是对供区肌肉血供有一定影响.结论 应用血管移植可以重建缺损掌浅弓的连续性,恢复远端手指血液供应;不同部位血管移植修复缺损掌浅弓的手术方式及手术繁易程度存在差异,并均有一定缺陷;临床上寻找一种新的、适宜的血管供区,是血管移植重建掌浅弓缺损的研究方向.

Objective To review the progress on the reconstruction of superficial palmar arch defect with vascular transplantation. Methods The literatures were searched by using the keywords of vascular system injuries, superficial palmar arch, vascular grafting, vein grafts, arterial graft, in the database of PubMed, CNKI, and Wanfang. Articles about reconstruction of superficial palmar arch defect with vascular transplantation before December 2016 were searched and analyzed. Results For the damage injury of superficial palmar arch, the transplantation of superficial vein and small arterial are mainly used to reconstruct the vascular defect. Different methods have different advantages and disadvantages. Foot vein transplantation mainly adopts end-to-side anastomosis, and this method can provide adequate stomas. The operation is difficult. Y-type vein transplantation needs to bridge the vessels in series. The advantage is that the remote can provide multiple stomas. But the operation is complicated. The diameter of the vessel is different from that of the vessel of recipient site. Forearm vein net transplantation can resolve the mismatching of donor site with recipient site. The anatomy of the vein net is instable, and the operative procedure is difficult. The morphology and caliber of dorsal venous arch of hand are similar to those of superficial palmar arch, and the surgical resection and anastomosis are easy. The valve obstruction and obvious scar are the limitations. Reconstruction the defect of superficial palmar arch using arcus venosus dorsalis pedis transplantation can resolve the mismatching of the vessel in diameter and amount, but the difficulty is bloodstream obstruction due to the valves. Reconstruction the superficial palmar arch defect using small arterial graft is reliable, while the disadvantage is the influence on blood supply to the muscle of donor site. Conclusions Vascular graft can be used to reconstruct the defect of superficial palmar arch and restore blood flow to the distal fingers. Repairing of the defect of superficial palmar arch with vascular graft of different site varied in surgical procedure and the difficulty of the surgery, and these methods have some defects in certain aspects. Searching for a new and suitable donor site with a vascular network has become the trend in the reconstruction of the superficial palmar arch defect.