臨時血管轉流術在快速重建肢體血供中的應用_《中國修復重建外科雜志》

作者：

朱慶棠 , 鄭燦鑌 , 戚劍 , 顧立強 , 傅國 , 秦本剛 , 王東 , 李平 , 李智勇 , 向劍平 , 劉小林

中山大學附屬第一醫院顯微創傷骨科（廣州，510080）;

關鍵詞：

臨時血管轉流術血管重建四肢創傷腫瘤

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【摘要】目的報告臨時血管轉流術（temporary intravascular shunts，TIVS）用于快速重建肢體血供的初步體
會。方法 2009 年8 月－ 2011 年3 月，對6 例8 條肢體大血管因外傷（4 例5 條）或腫瘤切除（2 例3 條）需行血管移
植且預期肢體缺血時間較長者，術中采用TIVS 重建肢體遠端血供，轉流方式包括頸外動脈- 鎖骨下動脈、腋動脈- 腋動
脈、腋靜脈- 鎖骨下靜脈、肱動脈- 肱動脈、肱靜脈- 肱靜脈、肱動脈- 橈動脈、股動脈- 腘動脈、腘動脈- 脛后動脈。然后
行徹底清創、骨折復位固定或腫瘤切除，再移除轉流管，其中6 條血管取自體大隱靜脈移植重建，1 條血管直接無張力吻合，
1 條血管采用人造血管移植修復。結果患者均成功置入轉流管，建立血管轉流時間為5 ～ 10 min，平均8.2 min；轉流
時間67 ～ 210 min。建立轉流后，肢體遠端血循環改善。移除轉流管時，除1 條轉流管內有血栓形成、部分堵塞外，其余
均保持通暢。術中未發生轉流管松脫、大出血等相關并發癥。1 例因術后軟組織壞死、感染，行肘上截肢術，其余5 例均保
肢成功，術后隨訪2 ～ 15 個月，受累肢體血供良好。結論 TIVS 操作簡便、快捷，可快速重建血管損傷肢體的血供，縮
短肢體缺血時間。

引用本文： 朱慶棠,鄭燦鑌,戚劍,顧立強,傅國,秦本剛,王東,李平,李智勇,向劍平,劉小林. 臨時血管轉流術在快速重建肢體血供中的應用. 中國修復重建外科雜志, 2012, 26(2): 231-234. doi: 復制

1.	Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
2.	羅庚, 郭現輝, 李燕山, 等. 顯微外科技術修復四肢主干血管損傷的療效分析. 中華顯微外科雜志, 2011, 34(1): 66-67.
3.	Davidovic LB, Cinara IS, Ille T, et al. Civil and war peripheral arterial trauma: review of risk factors associated with limb loss. Vascular, 2005, 13(3): 141-147.
4.	鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷延誤修復的原因分析. 中華創傷骨科雜志, 2011, 13(4): 392-394.
5.	McHenry TP, Holcomb JB, Aoki N, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma, 2002, 53(4): 717-721.
6.	Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1): 67-70.
7.	Borut LT, Acosta CJ, Tadlock LC, et al. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up. J Trauma, 2010, 69(1): 174-178.
8.	Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma, 2010, 68(5): 1117-1120.
9.	Hancock H, Rasmussen TE, Walker AJ, et al. History of temporary intravascular shunts in the management of vascular injury. J Vasc Surg, 2010, 52(5): 1405-1409.
10.	Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma, 2002, 52(6): 1129-1133.
11.	Choudry R, Schmieder F, Blebea J, et al. Temporary femoral artery bifurcation shunting following penetrating trauma. J Vasc Surg, 2009, 49(3): 779-781.
12.	Taller J, Kamdar JP, Greene JA, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? J Trauma, 2008, 65(3): 595-603.
13.	孫如泉, 劉澤, 張遠林, 等. 動脈臨時性橋接技術在四肢骨折合并血管損傷中的應用. 中華創傷雜志, 2004, 20(9): 566-567.
14.	Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg, 2004, 40(1): 61-66.
15.	Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular injury: collective review. Injury, 2008, 39(9): 970-977.
16.	張澤峰, 徐振海, 姚繼方, 等. 心血管外科技術在腫瘤切除術中的應用. 山東醫藥, 2005, 45(33): 32.
17.	Hemming AW, Reed AI, Fujita S. Ex vivo extended left hepatectomy with caval preservation, temporary portacaval shunt, and reconstruction of the right hepatic vein outflow using a reversed portal vein bifurcation graft. J Hepatobiliary Pancreat Surg, 2006, 13(6): 525-529.
18.	Granchi T, Schmittling Z, Vasquez J, et al. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg, 2000, 180(6): 493-497.
19.	鄭燦鑌, 朱慶棠, 秦本剛, 等. 簡便快速重建損傷肢體血供一例報告. 中華創傷骨科雜志, 2011, 13(5): 497-498.
20.	Nalbandian MM, Maldonado TS, Cushman J, et al. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient-a case report. Vasc Endovascular Surg, 2004, 38(4): 375-379.

1. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
2. 羅庚, 郭現輝, 李燕山, 等. 顯微外科技術修復四肢主干血管損傷的療效分析. 中華顯微外科雜志, 2011, 34(1): 66-67.
3. Davidovic LB, Cinara IS, Ille T, et al. Civil and war peripheral arterial trauma: review of risk factors associated with limb loss. Vascular, 2005, 13(3): 141-147.
4. 鄭燦鑌, 朱慶棠, 顧立強, 等. 四肢主要動脈鈍性損傷延誤修復的原因分析. 中華創傷骨科雜志, 2011, 13(4): 392-394.
5. McHenry TP, Holcomb JB, Aoki N, et al. Fractures with major vascular injuries from gunshot wounds: implications of surgical sequence. J Trauma, 2002, 53(4): 717-721.
6. Eger M, Golcman L, Goldstein A, et al. The use of a temporary shunt in the management of arterial vascular injuries. Surg Gynecol Obstet, 1971, 132(1): 67-70.
7. Borut LT, Acosta CJ, Tadlock LC, et al. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up. J Trauma, 2010, 69(1): 174-178.
8. Ball CG, Feliciano DV. Damage control techniques for common and external iliac artery injuries: have temporary intravascular shunts replaced the need for ligation? J Trauma, 2010, 68(5): 1117-1120.
9. Hancock H, Rasmussen TE, Walker AJ, et al. History of temporary intravascular shunts in the management of vascular injury. J Vasc Surg, 2010, 52(5): 1405-1409.
10. Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma, 2002, 52(6): 1129-1133.
11. Choudry R, Schmieder F, Blebea J, et al. Temporary femoral artery bifurcation shunting following penetrating trauma. J Vasc Surg, 2009, 49(3): 779-781.
12. Taller J, Kamdar JP, Greene JA, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? J Trauma, 2008, 65(3): 595-603.
13. 孫如泉, 劉澤, 張遠林, 等. 動脈臨時性橋接技術在四肢骨折合并血管損傷中的應用. 中華創傷雜志, 2004, 20(9): 566-567.
14. Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg, 2004, 40(1): 61-66.
15. Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular injury: collective review. Injury, 2008, 39(9): 970-977.
16. 張澤峰, 徐振海, 姚繼方, 等. 心血管外科技術在腫瘤切除術中的應用. 山東醫藥, 2005, 45(33): 32.
17. Hemming AW, Reed AI, Fujita S. Ex vivo extended left hepatectomy with caval preservation, temporary portacaval shunt, and reconstruction of the right hepatic vein outflow using a reversed portal vein bifurcation graft. J Hepatobiliary Pancreat Surg, 2006, 13(6): 525-529.
18. Granchi T, Schmittling Z, Vasquez J, et al. Prolonged use of intraluminal arterial shunts without systemic anticoagulation. Am J Surg, 2000, 180(6): 493-497.
19. 鄭燦鑌, 朱慶棠, 秦本剛, 等. 簡便快速重建損傷肢體血供一例報告. 中華創傷骨科雜志, 2011, 13(5): 497-498.
20. Nalbandian MM, Maldonado TS, Cushman J, et al. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient-a case report. Vasc Endovascular Surg, 2004, 38(4): 375-379.

《中國修復重建外科雜志》

臨時血管轉流術在快速重建肢體血供中的應用

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《中國修復重建外科雜志》

臨時血管轉流術在快速重建肢體血供中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料