血管移植三种术式修复四肢血管损伤的疗效评价

发布时间：2018-03-14 08:25

本文选题：四肢血管损伤　切入点：血管移植　出处：《中国矫形外科杂志》2017年14期 　论文类型：期刊论文

【摘要】：[目的]分析和评价显微缝合自体大隐静脉移植、吻合器自体大隐静脉移植与人工血管移植三种术式对四肢血管损伤的疗效。[方法]2014年1月~2015年12月,对89例(146条血管)肢体血管损伤行血管移植修复术。其中30例患者采用显微缝合自体大隐静脉移植术(显微缝合组),33例采用吻合器自体大隐静脉移植术(吻合器组),26例采用缝合人工血管移植术(人工血管组)。对3组围手术期相关指标及术后3个月随访结果进行对比分析。[结果]总手术时间分别为显微缝合组(353.13±6.49)min,吻合器组(217.27±8.30)min,人工血管组(288.64±4.53)min,三组间比较差异有统计学意义(F=596.91,P0.001)。总输血量分别为显微缝合组(2435.2±153.08)ml,吻合器组(1271.07±87.47)ml,人工血管组(1522.60±103.0)ml,三组间比较差异有统计学意义(F=141.909,P0.001)。吻合器组用时最短,输血量最少,差异有统计学意义(P0.001)。吻合器组和显微缝合组的术后并发症基本相当,均少于人工血管组,但三组血管术后通畅及血管危象比较差异无统计学意义(P0.05)。[结论]对肢体血管伤的处理须考虑患者的全身状况、局部伤情、供体条件、血管口径等因素。采用吻合器进行血管移植手术用时最短。自体大隐静脉移植时,血管直径4 mm,宜选择显微缝合术式;直径在1~4 mm之间,优先选用吻合器。人工血管仍可安全使用。
[Abstract]:[objective] to analyze and evaluate the curative effect of microsuture autologous saphenous vein transplantation, stapler autologous saphenous vein transplantation and artificial vascular transplantation on limb vascular injury. [methods] from January 2014 to December 2015. Vascular graft repair was performed in 89 cases (146 vessels) with limb vascular injury, of which 30 cases were treated by microsuture autograft of the great saphenous vein (33 cases of the microsuture group were treated with stapler autograft of the great saphenous vein). 26 patients in group A were treated with sutured artificial vascular transplantation (group A). The relative indexes of perioperative period and the results of follow-up 3 months after operation in 3 groups were compared and analyzed. [results] the total operative time was 353.13 卤6.49 min in microsuture group, and that in stapler group was 353.13 卤6.49 min, respectively. 217.27 卤8.30 min, 288.64 卤4.53 min in the artificial vessel group, there was significant difference among the three groups. The total blood transfusion volume was 2435.2 卤153.08 ml in the microsuture group, 1271.07 卤87.47 ml in the stapler group, 1522.60 卤103.0 ml in the artificial vessel group. The difference among the three groups was statistically significant. The volume of blood transfusion was the least, and the difference was statistically significant (P 0.001). The postoperative complications in the stapler group and the microsuture group were almost the same, which were less than those in the artificial vessel group. But there was no significant difference in patency and vascular crisis among the three groups. [conclusion] the treatment of limb vascular injury should take into account the patients' general condition, local injury condition and donor condition. Vascular diameter and other factors. It is the shortest time to use stapler for vascular transplantation. In autologous saphenous vein transplantation, the diameter of blood vessel is 4 mm, the microsuture is suitable, the diameter is between 1 and 4 mm, Stapling is preferred. Artificial blood vessels can still be safely used.
【作者单位】：西安交通大学医学院附属红会医院;兵器工业第521医院;西安交通大学医学院第二附属医院;
【分类号】：R658

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