战时周围血管创伤腔内快速修复救治策略的探索性研究  

Effect of endovascular first-aid repair for peripheral vascular trauma:A explorative study for war-time tactics to treat & cure

作　　者：陈众 张希全 钟山[2] 罗晓苗 公强[2] 窦树彬 

机构地区：[1]解放军148医院介入血管科(全军腔内介入诊疗中心),山东淄博255300 [2]潍坊医学院,山东潍坊在读硕士研究生261000

出　　处：《实用医药杂志》2017年第7期577-581,共5页Practical Journal of Medicine & Pharmacy

基　　金：原济南军区后勤科研计划重点项目(CJN14J010)

摘　　要：目的通过临床周围血管创伤腔内修复治疗的效果观察,推演性探索战时创伤的救治策略。方法 2009年9月—2015年12月,采用腔内修复方法治疗周围动脉损伤26例。血管造影确定血管创伤具体部位,精确测量创伤段动脉直径和长度。导管、导丝相互配合送至损伤部位并建立"工作轨道"。若导丝通过血管受阻,穿刺远端动脉,经创伤段动脉近、远段,采用导丝抓捕技术贯通动脉损伤段,建立"工作轨道"。经健侧股动脉或患侧远端动脉植入血管支架,修复血管损伤部位。结果 26例均取得腔内修复成功,无围手术期死亡及手术相关并发症发生。随访时间3~48个月,平均(20.8±12.7)个月,病例随访行CT血管造影或彩色多普勒检查,均无明显异常;所有随访病例每年1次的血管造影检查,仅2例支架腔内出现狭窄但未超过50%,仅给予球囊扩张。均未发现支架断裂、移位、变形情况。结论周围血管创伤腔内修复治疗,创伤小、手术时间短、术后恢复快,中、远期疗效肯定;为战时血管创伤的快速救治,提供了理论依据和技术支撑。Objective Through observing the clinical outcomes of endovascular repair for peripheral vascular trauma to exploratively study the war-time tactics to treat ＆ cure this trauma. Methods From September 2009 to December 2015,the 26 patients with peripheral vascular trauma were treated with endovascular repair. Angiography was performed to determine the specific site of vascular trauma,the diameter and length of the injured artery segment were measured. The catheter and guide wire were matched with each other to be sent to the damaged site and the working track was established. The distal artery was punctured after the guide wire was blocked by the vessel,and then proximal and the distal segment of the injured artery segment may be used to establish working track. The stent or stent-graft was implanted through the contralateral femoral artery or distal end of ipsilateral artery to repair the injured artery segment. Results All 26 patients were treated successfully with endovascular repair without perioperative death and procedure-related complications. All of them were followed up for 3 to 48 months （mean 20.8-12.7 months）;and by CT angiography or color Doppler examination and had no abnormality on CTA or color Doppler ultrasonography. Angiography was performed once a year. Only 2 patients with stent lumen stenosis less than 50% showed by angiography secondaryly received balloon angioplasty. The fracture,displacement and deformation were not found in all 26 patients. Conclusion Endovascular repair of peripheral vascular trauma has the advantages of less invasion,shorter operative time and rapid postoperative recovery. Medium and long-term results are significant. It provides a theoretical basis and technical support for rapid treatment of vascular trauma in war-time.

关 键 词：周围血管 创伤和损伤 战时 腔内修复 支架 

分 类 号：R654.3[医药卫生—外科学]