血管旁路移植术在四肢严重创伤患者保肢治疗中的应用

Therapeutic effects of vascular bypass grafting in limb salvage treatment for patients with severe four limbs trauma

目的探讨血管旁路移植术在四肢严重创伤伴主干血管缺损治疗中的疗效。方法选择2015年1月至2019年7月收治的四肢严重创伤的患者74例,以是否采用旁路移植为标准,患者分为治疗组(39例)和对照组(35例),对比2组患者的治疗效果。结果与对照组比较,治疗组患肢存活率为100%显著高于对照组的82.86%(P=0.009);治疗组术后血管通畅率明显高于对照组(P=0.001),吻合口破裂出血及血栓形成率均低于对照组(P=0.046,P=0.013);治疗组平均住院时间短于对照组(P=0.000);2组患者手术时间无明显差异(P=0.06);治疗组移植血管长度[(7.31±0.58)cm]大于对照组[(5.49±0.60)cm](P=0.000)。结论血管旁路移植术在四肢严重创伤保肢治疗中,可有效降低吻合口破裂出血及血栓形成率,提高血管通畅率,继而提高了保肢成功率,值得推广应用。

Objective To investigate the therapeutic effects of vascular bypass grafting in limb salvage treatment for patients with severe four limbs trauma.Methods A total of 74 patients with severe four limbs trauma who were admitted and treated in our hospital from January 2015 to July 2019 were enrolled in the study.According to whether bypass grafting was performed or not,these patients were divided into treatment group(n=39)and control group(n=35).The therapeutic effects were observed and compared between the two groups.Results The survival rate of the affected limb in treatment group was 100%,which was significantly higher than that(82.86%)in control group(P<0.01).The postoperative vascular patency rate in treatment group was significantly higher than that in control group(P<0.01),however,the anastomotic rupture hemorrhage rate and thrombosis rate were significantly lower than those in control group(P<0.05).Moreover the average hospitalization days in treatment group were significantly less than those in control group(P<0.05).There was no significant difference in operation time between the two groups(P>0.05).The length of transplanted vessels in treatment group was(7.31±0.58)cm,which was significantly longer than that[(5.49±0.60)cm]in control group(P<0.01).Conclusion The vascular bypass grafting can effectively reduce the incidence of complications including anastomotic rupture hemorrhage and thrombosis,improve vascular patency rate,so as to improve the success rate of limb salvage treatment in patients with severe four limbs trauma,therefor,which is worthy of clinical application.