中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (05): 436-438.

• 论著 • 上一篇    下一篇

下肢血管损伤43例诊治分析

王利新，郭大乔，符伟国，徐 欣，陈 斌，蒋俊豪，杨 珏，史振宇，董智慧，石 赟，竺 挺，唐 骁，王玉琦   

  1. 复旦大学附属中山医院血管外科研究所，上海200032
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-05-13 发布日期:2009-05-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-05-13 Published:2009-05-13

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摘要：

目的 探讨下肢血管损伤病变特点、总结诊断与治疗经验。方法 分析复旦大学附属中山医院2002年6月 至 2007年5月诊治的43例血管外伤病人的临床资料，30例为下肢动脉血管损伤，其中男性病人26例。主要为动脉血管损伤，其中髂外动脉损伤5例，股浅动脉损伤10例，股总动脉损伤7例，腘动脉损伤5例，股深动脉损伤2例，胫腓干损伤1例。3例病人因动静脉瘘同时合并静脉损伤。22例病人接受开放手术治疗，6例病人行腔内治疗，2例病人接受药物治疗。结果 开放手术组中2例发生骨筋膜室综合征和缺血再灌注损伤，其中1例因救治无效而死亡，1例经保守治疗后症状缓解；2例腘动脉损伤合并骨折者术后因血管再次栓塞而行截肢术，其余19例术后恢复良好。开放手术组中1例死亡者和2例截肢者失访，其余19例随访2～36个月，1例病人36个月发生人工血管吻合口处中度狭窄，ABI 0.75，其余病人下肢情况良好，无严重并发症发生。腔内治疗组术后症状消失，病人随访6~24个月，支架通畅，无并发症发生。药物组治疗后症状缓解，2例病人随访时间分别为1个月和12个月，间破距离较治疗前延长。结论 下肢血管损伤发病率不高，尽管近年来救治手段有了较大提高，仍有一定的致死率和致残率。腔内治疗是治疗血管外伤的新方法，与传统手术相比有较多优点，短期随访结果满意。

关键词: 下肢, 血管损伤, 腔内治疗, 血管内支架

Abstract:

Diagnosis and treatment of lower extremity vascular injury WANG Li-xin, GUO Da-qiao，FU Wei-guo，et al. Institute of Vascular Surgery，Zhongshan Hospital，Fudan University, Shanghai 200032，China Corresponding author: GUO Da-qiao，E-mail：guodaqiao@zshospital.net Abstract Objective To evaluate the clinical features, diagnosis and treatment of lower extremity vascular injury. Methods The clinical data of 43 cases of vascular injury admitted between June 2002 and May 2007 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of them, 30 cases were suffered from lower extremity vascular injury. Twenty-two cases received open surgery. Six cases underwent endovascular therapy. Two cases were given medical therapy for no surgical indication. Results Open surgery group: In the peri-operative session, 2 cases were complicated with osteofascial compartment syndrome and reperfusion injury, which resulted in one death; 2 cases with popliteal arteries injury received amputation for re-thrombosis of the treated vessel. Except one death and two amputation cases, all other 19 cases were followed up for 2～36 months. One case was suffered from moderate anastomotic stoma stenosis after 36 months with the ABI declined to 0.75. No complication was identified in the other cases. Endovascular repair group: In the peri-operative session, the symptoms due to the vascular injury were totally relieved without severe complication occurred. The patients were followed up for 6～24 months. The stents implanted were patent and no complication was found. Medical treatment group: The ischemic symptoms were alleviated after the medical therapy. Two cases were followed up for 1 and 12 months respectively and the intermittent claudication distance were both increased. Conclusion Despite of technical improvements in diagnosis and management of vascular injury, the morbidity and mortality still could not be avoided. Endovascular therapy is a new method in the management of vascular injury, offering a promising alternative to operative repair and the short to mid term follow up outcome was satisfied.

Key words: lower extremity, vascular injury, endovascular repair, endovascular stent