血管损伤的外科处理

目的: 探讨血管损伤的外科处理方法。方法:分析总结59例血管损伤的临床资料。颈部及四肢血管损伤55例，门静脉及下腔静脉损伤4例，其中股动脉损伤并感染21例，介入并发血管损伤4例。四肢或颈部血管破裂或横断病例入院前多已给予压迫止血或抗休克治疗。所有股动脉损伤并感染病例均行血管结扎并脓肿引流术，其余患者根据病情行对端吻合术（11例），血管移植术（12例），血管修补术（14例）。结果:死亡2例；截肢5例（其中1例介入治疗误栓股动脉）；21例股动脉感染破裂者术后出现间歇性跛行、皮温低等缺血表现，但无1例下肢坏死；其余患者均痊愈出院。结论:血管损伤首先应立即给予局部止血或抗休克处理，以抢救患者生命，再根据血管损伤情况进行处理，尽可能保存肢体。血管重建是血管损伤的主要治疗手段，股动脉损伤并感染者可行动脉结扎术。

Surgical treatment of vascular injury

Abstract:Objective:To study the management of vascular injury. Methods:Retrospective analysis was made on the clinical data of 59 cases of vascular injury, including 55 cases of vascular injury in neck and extremity and 4 cases of portal vein and vena cava injury. Among them, 21 cases had femoral artery injury with infection and 4 cases had vascular injury due to intervention therapy. All patients with vascular wound of extremity or neck had undergone hemostasis by compression and antishock treament before hospital admission. All cases of femoral artery injury with infection underwent hemostasis by arterial ligation and incision and drainage of abscess. Vascular anastomosis was performed in 11 cases, vascular grafting in 12 cases, and vascular repair in 14 cases. Results:There were 2 deaths. 5 cases had amputation(including a case of femoral embolism due to intervention trerapy). Postoperative intermittent claudication, decreased skin temperature and other signs of ischemia occurred in 21 cases of femoral artery injury with infection, but none developed limb gangrene. The other cases were discharged in good health. Conclusions:In the treatment of vascular injury, wound hemostasis and antishock treatment should be done first to save the patient′s life and the management of the vascular injury depends on the situation, with the aim to try by all means to save the extremity.Vascular reconstruction is the main method for treatment of vassular injury. Vascular ligation can be done in cases of femoral artery injury with infection.