DSA在断指再植血管评价中的价值  

DSA in digital replantations

作　　者：王六红[1] 晁明[1] 蒋定尧[1] 张广强[1] 伍建军[1] 陈贤谊[1] 李斌[1] 孙继红[1] 

机构地区：[1]浙江大学医学院第二附属医院放射科,杭州310009

出　　处：《中华放射学杂志》2008年第2期189-191,共3页Chinese Journal of Radiology

摘　　要：目的探讨DSA在评价断指再植血管及血流状况中的价值。方法12例断指再植患者术后2～4d行再植指体DSA检查，观察再植指体血管轮廓、吻合口形态、血液动力学改变、有无血管痉挛或血栓及侧支循环建立情况，根据造影结果确定进一步的处理方案。结果共27条吻合血管中，DSA全部显示清晰，其中9例23条吻合血管血流通畅，均存活，断指再植指体早期存活诊断符合率为100％（23／23）。2例（右手中指和无名指各1例）吻合血管中断，考虑重度血管危象，即行手术探查发现血栓；1例（左手无名指和小指）吻合动脉痉挛变细，提示轻度血管危象，经保守治疗最终存活。DSA对4条吻合血管病变均检出。结论DSA能够对再植指体血供重建和血液循环情况作出客观、准确的评价，在指导临床对再植指体的进一步处理及预测再植指体早期存活方面具有重要意义。Objective To assess revascularization and vessel anastomosis in digital replantations with DSA. Methods Twelve cases of digital replantations underwent digital subtract angiography during 2 to 4 days after fingers reattachment The vessel anastomosis, hemodynamics, stenesis and discontinuation were investigated. The unobstructed and smooth anastomosis was suggested as early stage survival of the reattached fingers, the spasm and stenesis of the reattached vessels were considered as mild vascular crisis, and the discontinuation of hemodynamics were indicated as severe vascular crisis. Results The total 27 vessels were clearly displayed on DSA. Of these vessels, 23 vessels were unobstructed and smooth, all digits were survived. Diagnosis coincidence of early stage survival was 100% （23/23）. Two vessels were obstructed, which were testified having thrombus by operation research. The other 2 vessels were spasm, the digits were also survived ultimately by expectant treatment. All 4 abnormal vessel anatomosis were found by DSA. Conclusion DSA is important modality in assessing revascularization and blood circulation for digital replantations, guiding in dealing with the vascular crisis, and in predicting early stage survival of the reattached digits.

关 键 词：吻合术 外科 血管造影术 数字减影 动脉 静脉 

分 类 号：R686[医药卫生—骨科学]