锁骨下动脉损伤开放手术与腔内手术治疗的比较  

Open and endovascular surgery for subclavian artery injury

作　　者：成军[1] 赵渝[1] 张矛[1] 任为[1] 黄文[1] 

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《第三军医大学学报》2011年第17期1872-1874,共3页Journal of Third Military Medical University

摘　　要：目的比较外科手术治疗和腔内手术治疗锁骨下动脉损伤及创伤性假性动脉瘤的方法和特点。方法收集21例锁骨下动脉损伤病例。开放手术12例,根据损伤的部位、程度及受伤时间、累及范围等,选择锁骨上、下切口,胸骨正中切口、经肋间联合左颈部切口等,采用血管壁修补、血管吻合、血管移植、血管缝扎,辅助体外循环及球囊止血技术。腔内治疗9例(中转手术1例),急性锁骨下动脉损伤伴出血性休克4例,外伤后锁骨下动脉闭塞2例,外伤性锁骨下假性动脉瘤2例,成功实施腔内治疗。结果患者均痊愈,开放手术组和腔内治疗组的平均手术时间、平均出血量、住院时间分别为4.5 h和2.1 h、1 800 ml和200 ml、21.3 d和9 d,两组差异显著(P<0.05)。随访4～30个月,1例血管手术修补病例出现部分血管狭窄,所有支架植入病例血管通畅,无严重狭窄及闭塞发生。结论锁骨下动脉损伤及创伤性假性动脉瘤腔内治疗较开放手术安全、可靠、微创、并发症少,疗效满意。Objective To compare the open and endovascular surgery for subclavian artery injury and traumatic pseudo-aneurysm.Methods Twenty-one patients with subclavian artery injury were enrolled in this study.Of them,12 underwent open surgery according to the site,severity,time,and involved area of their injury,through supra-and sub-clavian incision,sternal midline incision,trans-rib left neck incision,with the following techniques such as vascular wall repair,vascular anastomosis,vascular transplantation,vascular suture and ligation,auxiliary extracorporeal circulation or balloon hemostasis,and 9（1 in failure,4 with hemorrhagic shock,and 2 with traumatic artery occlusion） underwent endovascular surgery.Results The injury was completely healed in all patients.The mean operation time of endovascular surgery and open surgery was 2.1 h and 4.5 h,respectively（P0.05）,and the mean average blood loss was 200 ml and 1 800 ml in two groups,respectively（P0.05）.The hospital stay time of the two groups was 9 and 21.3 d,respectively（P0.05）.The patients were followed up for 4-30 months,during which partial vascular stenosis occurred in 1 patient after repair.The stent patency was 100% with no severe vascular stenosis and occlusion occured.Conclusion Endovascular surgery is a safe procedure for subclavian artery injury and traumatic pseudo-aneurysm with less minimal invasive injuries and complications than open surgery.

关 键 词：锁骨下动脉损伤 创伤性假性动脉瘤 外科手术 腔内治疗 覆膜支架 

分 类 号：R615[医药卫生—外科学] R654.4[医药卫生—临床医学]