火器性四肢动脉伤：附50例报告

作者报告５０例５２条四肢火器性动脉伤，其中枪弹伤３７例，弹片伤１３例；急性动脉伤３２例（３３条），晚期动脉伤８例，假性动脉瘤７例，动静脉瘘３例（４条）。平均随访２４．２个月，无一例死亡，修复血管通畅率９３％，截肢率９．８％，肢体缺血性挛缩发生率１０．９％。作者强调，早期诊断、早期正确处理此类动脉伤是成功的关键。应争取在伤后６～１２小时内修复损伤血管。根据临床表现可作出诊断，急性动脉伤一般不做血管造影，对可疑肢体主要动脉伤应积极手术探查。根据伤情采用对端吻合或自体静脉移植修复血管，不主张用人造血管修复，血管部分断裂不宜做侧壁吻合。晚期动脉伤应争取修复血管以改善肢体循环。假性动脉瘤和动静脉瘘宜早期切除修复血管，待伤口愈合、组织柔软后即可手术。     

同种异体血管移植的实验研究与临床应用

选５０只Ｗｉｓｔａｒ鼠分成Ａ、Ｂ两组，每组２５只，Ａ组移植低温贮存的同种异体颈动脉３０条（其中５只行双侧颈动脉移植），Ｂ组移植自体颈动脉２５条．Ａ、Ｂ两组通畅率分别为９０％和９２％，两组组织学变化类似，无明显排异反应．作者用低温贮存的同种异体血管修复了６例７条血管，缺损血管平均长４．７５ｃｍ（１．０～１５．０ｃｍ），缺损血管平均外径２．０３ｍｍ，平均随访１９．６个月（１３～３６个月），５例良好，１例失败．     

人造血管在四肢血管损伤修复中的应用体会

目的 报道应用人造血管移植修复四肢主要血管损伤的临床效果.方法 采用Gore-Tex膨体聚四氟乙烯(ePTFE)人造血管移植修复四肢主要血管损伤40例,修复血管缺损长度3.0～8.0 cm,平均10.5 cm;血管直径0.4,～1.0 cm,平均0.7 cm.并对结果进行研究分析.结果 进行人造血管移植40例,其中32例获得术后5个月～3年随访,术后肢体血液循环良好,经彩色多普勒检查显示血管通畅,属优良循环23例,良好循环9例,术后局部发生皮肤坏死4例,经植皮及皮瓣覆盖创面,肢体成活.结论 人造血管移植修复四肢主要血管损伤,治疗效果满意,是一种安全有效的手术方式.     

血管移植在肢体血管损伤中的应用

目的 总结应用血管移植在肢体血管损伤修复中的临床效果。方法 采用自体静脉和人工血管,用不同的吻合方式对５３条损伤的血管进行血管移植。结果 除２例术后截肢外,其余移植血管均通畅,远端肢体循环良好,肢体无肿胀。结论 动脉、静脉损伤２ｃｍ以上均需行血管移植,尽量采用自体静脉移植,必要时可使用人造血管,血管吻合时应遵循显微外科原则。     

人造血管移植在四肢血管损伤中的应用

自2003年1月～2005年7月,共收治四肢主要动脉损伤37例,其中采用人造血管移植修复13例,除1例术后截肢外,其余移植血管均通畅,远端肢体血液循环良好,肢体无肿胀.报告如下.     

同种异体动脉在四肢大血管损伤中的应用

目的探讨应用经深低温处理的异体动脉移植修复损伤、缺损的四肢大血管的疗效。方法2003年5月～2005年10月,应用同种异体动脉移植修复四肢大血管损伤15例(17条血管),其中肱动脉缺损6例,胴动脉缺损1例,股动脉缺损7例,1例上肢完全离断伤异体动脉修复肱动静脉、头静脉3条。移植血管平均长度9．5 cm。结果15例术后均无排异反应,伤口一期愈合13例,二期愈合2例,伤口愈合后经超声多谱勒检测,血管通畅率为100%,随访4～12个月(平均9个月),肢体功能恢复良好,无迟发排异反应发生。参照周之德四肢功能恢复评定标准：优11例,可3例,差1例。结论异体动脉经深低温处理后为修复四肢大血管损伤提供了较为理想的生物性材料,临床应用疗效良好。     

小动脉张力缝合的实验研究

对５８只家兔切除左右股动脉的直径１～５倍后行张力下缝合分组。动脉经一般游离后切断，造成血管缺损的距离为直径６．１倍；当切除动脉直径１～２倍时行张力下缝合，远期通畅率为１００％；若切除３～４倍行张力下缝合；远期通畅率为９２．３％～９０．５％；若切除５倍时则难以缝合。所以，当中小动脉断裂回缩后所致缺损距离为该动脉直径８倍以内时可作直接或张力下缝合，当缺损大于直径１０倍时应采用血管移植的方法修复。     

解剖外腋-股、股-股动脉旁路移植术治疗主髂动脉闭塞症

目的探讨解剖外腋股、股股动脉旁路移植术治疗主髂动脉闭塞症的疗效。方法采用解剖外旁路移植术治疗主髂动脉闭塞症患者３２例。１８例腹主动脉或两侧髂动脉闭塞者采用腋股动脉旁路术，其中２例为腋两股动脉旁路术；１４例单侧髂动脉闭塞者采用股对侧股动脉旁路术。采用腋股动脉旁路的患者，术中８例用真丝人造血管移植，１０例用聚四氟乙烯（ＧｏｒｅＴｅｘ）人造血管；股股动脉旁路术中６例用真丝人造血管移植，１例用自体大隐静脉，７例用ＧｏｒｅＴｅｘ人造血管。结果术后５年随访时，股股动脉旁路术通畅率为７８％，其中真丝人造血管与ＧｏｒｅＴｅｘ人造血管通畅率无明显差异；腋股动脉旁路术中，８例真丝人造血管均已闭塞，１０例ＧｏｒｅＴｅｘ人造血管中１例闭塞，１例发生腹股沟部假性动脉瘤。结论解剖外动脉旁路移植术操作简单，创伤小，无腹部手术并发症，手术安全，术后恢复快。真丝人造血管的使用应限于短段的股股动脉旁路术     

耳廓复合组织移植修复耳鼻缺损

１９８９年１１月～１９９３年９月，采用联合耳后真皮下血管网皮肤的耳廓复合组织块移植８例，其中修复鼻翼缺损６例，鼻尖、鼻翼缺损及小耳畸形各１例。切取耳廓复合组织块最大宽径为２．６ｃｍ，最小为１．８ｃｍ，联合耳后真皮下血管网皮肤０．８～２．２ｃｍ×１～２．５ｃｍ。手术均获得成功。对耳复合组织块移植成活的机理、手术成功的要点进行了讨论     

四肢血管损伤漏诊及再手术的原因探讨

目的探讨四肢血管损伤漏诊及再手术的原因。方法回顾性分析了149例四肢血管损伤病人的诊断和治疗方法,寻找漏诊及再手术的原因。结果漏诊8例,漏诊率5.4%,其中彩超诊断错误1例,因肢端皮温好漏诊4例,因可触及动脉搏动漏诊2例,因锐器割伤裂口自行封闭漏诊1例。再手术(再次血管探查)23例,再手术率15.4%,其中,19例因血管栓塞再次手术,4例因所移植的大隐静脉破裂再次手术。结论彩超并非绝对可靠,肢端皮温好不能排除动脉主干断裂,动脉搏动减弱或消失者主张早期探查血管。早期修复血管、正确熟练的镜下操作是手术成功的关键,对大段血管缺损者建议用人造血管移植修复。     

丝涤交织人造血管的研究

目的研制新型真丝涤纶交织人造血管。方法采用38杂杂种犬,麻醉后将直径8～10mm,长度3O～50mm直型丝涤人造血管移植于胸主或腹主动脉并与聚四氟乙烯管作对照。术后按要求观察移植物通畅度、内膜生长情况、生物相容性,细胞毒反应等。结果移植血管通畅率为35／38（921％）,移植后一月可完整形成新生的内膜和外膜,细胞毒性测试表明无毒性反应。结论新型丝涤交织人造血管是一种较理想的血管代用品,值得在临床推广使用。     

Efficacy and safety of sirolimus in the treatment of vascular anomalies: A systematic review

ObjectiveThe management of vascular anomalies is complex and requires a multidisciplinary team with a combination of medical, surgical, and intervention treatments. Medical treatment is limited and has conflicting results. Off-label use of mammalian target of rapamycin inhibitors shows promising results. The objective of this study was to systematically evaluate the literature published about the efficacy and safety of sirolimus in the treatment of vascular anomalies.MethodsA systematic review of the published literature was conducted using the PubMed database and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsThere were 73 articles included: 2 randomized controlled studies, 2 nonrandomized prospective studies, and 69 retrospective case reports and case series. In total, 373 patients were included. Sirolimus was administered topically to 56 patients and orally to 317 patients. Sirolimus was highly effective in the treatment of vascular tumors associated with Kasabach-Merritt phenomenon (95.5% of the patients clinically improved and 93% had normalization of coagulopathy), venous malformations (size reduction was observed in 88.9% of patients), and lymphatic malformations (clinical improvement in 94.9% of patients). Topical sirolimus results were conflicting. Arteriovenous malformations were not improved by sirolimus.ConclusionsLow-level evidence suggests that sirolimus can improve the prognosis of vascular anomalies, most notably vascular tumors associated with life-threatening coagulopathy and venous and lymphatic malformations. Further research is needed to establish the benefits of sirolimus in the management of vascular anomalies.     

膝关节完全脱位合并腘部血管损伤的处理（附11例报告）

膝关节完全脱位合并腘部血管损伤11例,经治疗10例成功。本文着重提出早期诊断的要点,认为只有及时诊断,早期手术探查,对不同类型的血管损伤,采取血管端端吻合,血管修补,大隐静脉移植术等方法,重建血循环和修复关节稳定结构,获得较为满意效果。     

周围动脉损伤的治疗

总结周围动脉损伤74例,以上肢和下肢主干动脉为多。其中,行血管端端吻合28例,裂口修补12例,自体静脉移植20例,动脉结扎7例,未探查血管7例。74例中死亡1例,截肢16例。根据本组病例治疗结果,认为动脉损伤后应尽早处理,其方法主要采用血管修复。软组织及血管的彻底清创,良好的修复技术,骨折妥善固定,彻底止血,与动脉伴行的主干静脉的探查与修复,远端肢体筋膜充分减压,恰当引流以及术中术后局部及全身抗凝剂的应用对治疗动脉损伤均十分重要。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例（52条）四肢血管损伤患者,男35例,女9例,年龄14⁵8岁,平均27·3岁,分别采用自体血管（42条）和人造血管（10条）移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

Experimental study and clinical application of an air pressure vascular clamp

An air pressure vascular clamp was developed for vascular surgery. On 90 rats, 172 vascular injury experiments and 37 vascular anastomoses experiments were done to compare this clamp with two other vascular clamps commonly used clinically. Using light and electron microscopic examinations, it was found that the air pressure vascular clamp was superior. Satisfactory results have been obtained in clinical applications on 43 patients with 119 vascular anastomoses.     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例(52条)四肢血管损伤患者,男35例,女9例,年龄14~58岁,平均27·3岁,分别采用自体血管(42条)和人造血管(10条)移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

Vascular tone estimation in patients implanted with the AbioCor implantable replacement heart

The AbioCor implantable replacement heart provides continuous hydraulic pressure data that are used for control purposes. The magnitude of the end systolic pressure spikes are compared to a preset threshold and used for controlling motor speeds to maintain a full stroke on every beat. Portions of the diastolic pressures of the left and the right side are averaged and can be used for left-right balance control. The mean right diastolic pressure may be used for beat rate (cardiac output) control. The systolic and diastolic hydraulic pressures of the left and right side are correlatable to the respective afterload and preload pressures. More importantly, with known hydraulic pump pressure-flow characteristics, cardiac output is derived. The slopes of the hydraulic pressure traces as a function of time are not used for control or monitoring purposes. However, the magnitudes and shapes of these slopes can provide information on the tones of a patient's vasculature. The ratio of the slope of the systolic pressure to that of the stroke volume yields the vascular tone given in mm Hg/cc. Due to pre-existing pulmonary complications, some AbioCor patients have pulmonary vascular tones that are substantially higher than their respective aortic tones by as much as a factor of four. Pulmonary tones as high as 2 mm Hg/cc, or approximately ten times the normal tone, are recorded. The ratio of averages of the aortic to the pulmonary tone range between 2.2 and 0.25 in patients implanted with the AbioCor compared with a normal value of 5 in subjects without pre-existing pulmonary diseases. The AbioCor implantable replacement heart's hydraulic drive system is capable of providing valuable physiological information, including estimates of physiological pressures, cardiac outputs, and vascular tones.     

The spectrum and management of noniatrogenic vascular trauma in the pediatric population

Background

To describe the spectrum of noniatrogenic pediatric vascular injuries and their outcomes at a large tertiary pediatric hospital.

急性肢体动脉缺血148例的治疗体会

目的 探讨治疗急性肢体动脉缺血的经验。方法 总结1980～2001年采用手术、介入和溶栓抗凝等方法治疗的148例急性肢体缺血患者的临床资料。结果 本组148例中，发病后12h以内就诊者22例，治愈率95．5％，死亡率4．5％；12～24h就诊者91例，治愈率64．8％，改善率17．6％，截肢率9．9%，死亡率7．7％；24h以上就诊者35例，治愈率20％，改善率34．3％，截肢率25．7％，死亡率20％；非手术治疗19例，治愈率10．5％，改善率73．7％，截肢率15．8％。结论 早期诊断，选择适当的治疗措施，以及对全身疾病的有效治疗有望降低死亡率及致残率。