上肢血管损伤的诊治进展

Advances in diagnosis and treatment of upper extremity vascular injuries

上肢血管损伤战时发生率1%~3%,平时发生率较低,约为下肢血管损伤发生率的1/3。上肢血管按解剖部位分区可分为肩部、上臂、前臂和手部四个区域,动脉损伤常见,是上肢截肢的主要原因之一,可高达28%;近年来由于血管损伤诊断和修复技术的进步,截肢率已降至10%以下。由于上肢功能重要且复杂,目前上肢假肢技术仍无法提供满意功能,传统观念认为上肢血管损伤后,探查吻合是首选。近年来随着非侵入性影像学检查逐渐普及和血管腔内手术技术的进步,对上肢血管损伤诊治更趋精准化,大大提高了上肢动脉损伤的救治成功率。本文综述了近年来上肢血管损伤诊治进展,以供同道借鉴。

The incidence of upper extremity vascular injuries is 1%-3%in wartime,but much lower in peacetime as 0.192%,being only one third of that for lower extremity vascular injuries.The blood vessels of the upper extremities can be divided into four regions based on their anatomic location:shoulder,upper arm,forearm and hand.Arterial injuries are common and present one of the main reasons for upper extremity amputation,accounting for as high as 28%.Recently,due to the advances in diagnosis and repair of vascular injuries,the amputation rate has been reduced to be less than 10%.Because of the important and complex functions of the upper extremity,current prosthesis techniques are far from satisfaction.Traditionally,exploration and anastomosis is the first choice after upper limb vascular injuries.In recent years,with the gradual popularization of non-invasive imaging and advanced endovascular surgical techniques,the diagnosis and treatment of upper extremity vascular injuries is more precise,which greatly improves successful management of the upper extremity artery injury.This article reviews the recent progress of diagnosis and treatment of this injury for reference.