摘要
目的:探讨血管吻合器应用在上肢动脉损伤中的效果,明确吻合器的应用范围及适应证,达到优化血管吻合器在动脉损伤修复上的效果。方法:自2013年3月至9月,应用COUPLER血管吻合器对18例19条上肢动脉开放性损伤的男性患者进行血管修复,19条上肢动脉包括肱动脉3条、尺动脉6条及桡动脉10条。术中记录动脉损伤的部位、情况及有无合并性损伤、使用吻合器吻合血管的时间以及血管吻合的效果,术后随访患者的手部功能恢复情况,并通过彩色多普勒超声及专科检查检测动脉通血情况。结果:在18例患者的修复中,使用COUPLER吻合器吻合动脉平均手术时间278 s,术后患者随访时间最长116 d,最短14 d,平均(71.5±40.9)d,未发现因局部血管原因再次手术病例。18例中未发现栓塞和肢体血循环障碍的患者,Allen试验(-),彩色多普勒超声检测动脉吻合部位通畅,吻合血管两端均为动脉血流频谱。18例患者中仅3例桡动脉吻合患者主诉吻合部位有压痛,其余患者均告知肢体康复满意,达到了如期的治疗效果。结论:初步观察验证了COUPLER血管吻合器可快捷、有效、安全地用于上肢动脉损伤的修复,临床疗效较为肯定。
Objective： To investigate the outcomes of applying microvascular anastomotic coupling devices in solitary upper extremity artery injury repairs and to optimize parameters for optimal clinical outcome. Methods： From March to September 2013,19 injured arteries from 18 male patients who presented at Department of Hand Surgery,Beijing Jishuitan Hospital with traumatic arterial lacerations of their upper extremities went through rapid repair procedures. COUPLER,a microvascular anastomotic coupling device was applied in these artery injury repair operations. The 19 repaired arteries included 3 brachial arteries,6 ulnar arteries and 10 radial arteries. After the procedures,all the 18 patients were then followed up by clinical specialists and examined with color doppler flow imaging for the effective recovery of artery circulation and upper extremities functionality. Results： The average time of artery repairs for all the 19 damaged arteries among the 18 patients was 278 s and the average follow-up time was（ 71. 5 ±40. 9） d with the longest follow-up time as 116 d and shortest as 14 d. No patient returned to the operating room after the procedures and after being dismissed from the hospital. None of the 18 cases were reported to have problems with circulation and thrombosis formation in their upper extremities. Color Doppler imaging showed that the arterial anastomotic site for all the 19 repaired arteries were unobstructed with artery blood spectrum at both ends. Three patients with radial artery repairs complained about mild pressure pain at the site of vascular anastomosis; while the other 15 patients all expressed satisfactory outcomes of the surgery and recovery. These evidences indicated that the outcomes of our initial evaluation for the solitary upper extremity artery injury repairs by using anastomotic coupling devices were positive. Conclusion： Our observations have showed that microvascular anastomotic coupling devices can be used for repairing of solitary upper extremity artery injures. The procedures are quick,effective and safe.The clinical application of this microvascular anastomotic coupling device in artery injures is promising,however,additional evidences through further clinical investigation with more cases are warranted.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2016年第2期346-350,共5页
Journal of Peking University:Health Sciences
关键词
吻合术
外科
上肢
动脉损伤
Anastomosis
surgical
Upper extremity
Artery injure
