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目的 探讨血管火器伤海水浸泡后的外科处理方法。方法 将 1 0 0只白兔用 0 .38g钢珠弹致单侧股动脉伤后 ,分为海水浸泡组 (动物置于人工海水中浸泡 6 0min)和单一致伤组 (不浸泡 )。两组均切除动脉肉眼观损伤段 ,用直接端 端吻合、自体静脉或低温保存的同种异体动脉移植进行重建。术后 2 4h ,7、1 4、2 1d用多普勒超声监测血流通畅情况 ,对部分通畅和全部不通畅者行手术探查 ,取吻合口组织做光、电镜检查。结果 动脉完全断裂伤 :海水浸泡组和单一致伤组的 3周累计通畅率分别 80 .0 0 %和86 .6 7% ,两组间差异不显著 (P >0 .0 5 ) ;动脉挫伤 :海水浸泡组和单一致伤组的 3周累计通畅率分别为 86 .6 7%和 82 .35 % ,两组间差异不显著 (P >0 .0 5 )。两组均为术后 1周内发生血栓最多 ,1周后趋于稳定。两组均见术后 1周时吻合口附近有内皮细胞增生 ,术后 3周内皮化过程基本完成。结论 血管火器伤合并海水浸泡的外科处理中 ,仅切除肉眼观损伤段血管后用常规方法进行重建可获得满意的早期疗效 ,同种异体动脉是有一定应用前景的血管移植材料
Objective To investigate the surgical treatment of seawater immersion after vascular firearm injury. Methods One hundred rabbits were killed by unilateral femoral artery injury with 0.38g steel ball and divided into seawater immersion group (animals were immersed in artificial seawater for 60min) and single injury group (not immersed). Both groups were resected from the macroscopic injury segment of the artery and reconstructed with direct end-to-end anastomosis, autologous vein or cryo-preserved allograft. Doppler ultrasound was used to monitor the blood flow at 24 hours, 7 days, 14 days and 21 days after surgery. Surgical exploration was performed on patients who were partly or completely unobstructed. The anastomotic tissues were taken for light and electron microscopy. Results Complete arterial rupture: The cumulative 3-week patency rates in seawater immersion group and single injury group were 80.0% and 86.67% respectively, with no significant difference between the two groups (P> 0.05) The cumulative 3-week patency rates in seawater immersion group and single injury group were 86.67% and 82.35% respectively, with no significant difference between the two groups (P> 0.05). Both groups had the most thrombosis within one week after operation, and tended to be stable after one week. Both groups showed endothelial cell proliferation near the anastomosis at 1 week after operation, and the endothelialization process was basically completed after 3 weeks. Conclusions In the surgical treatment of vessel firearm injury combined with seawater immersion, only the macroscopic excision vessel is excised and the satisfactory early curative effect can be obtained by conventional method. Allograft artery is a promising material for vascular graft