• 中山大學(xué)附屬第一醫(yī)院顯微創(chuàng)傷骨科（廣州，510080）;

【摘 要】 目的 報(bào)告臨時(shí)血管轉(zhuǎn)流術(shù)（temporary intravascular shunts，TIVS）用于快速重建肢體血供的初步體
會(huì)。 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(yù)期肢體缺血時(shí)間較長者，術(shù)中采用TIVS 重建肢體遠(yuǎn)端血供，轉(zhuǎn)流方式包括頸外動(dòng)脈- 鎖骨下動(dòng)脈、腋動(dòng)脈- 腋動(dòng)
脈、腋靜脈- 鎖骨下靜脈、肱動(dòng)脈- 肱動(dòng)脈、肱靜脈- 肱靜脈、肱動(dòng)脈- 橈動(dòng)脈、股動(dòng)脈- 腘動(dòng)脈、腘動(dòng)脈- 脛后動(dòng)脈。然后
行徹底清創(chuàng)、骨折復(fù)位固定或腫瘤切除，再移除轉(zhuǎn)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(fù)。 結(jié)果 患者均成功置入轉(zhuǎn)流管，建立血管轉(zhuǎn)流時(shí)間為5 ～ 10 min，平均8.2 min；轉(zhuǎn)流
時(shí)間67 ～ 210 min。建立轉(zhuǎn)流后，肢體遠(yuǎn)端血循環(huán)改善。移除轉(zhuǎn)流管時(shí)，除1 條轉(zhuǎn)流管內(nèi)有血栓形成、部分堵塞外，其余
均保持通暢。術(shù)中未發(fā)生轉(zhuǎn)流管松脫、大出血等相關(guān)并發(fā)癥。1 例因術(shù)后軟組織壞死、感染，行肘上截肢術(shù)，其余5 例均保
肢成功，術(shù)后隨訪2 ～ 15 個(gè)月，受累肢體血供良好。 結(jié)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(shí)間。

引用本文： 朱慶棠,鄭燦鑌,戚劍,顧立強(qiáng),傅國,秦本剛,王東,李平,李智勇,向劍平,劉小林. 臨時(shí)血管轉(zhuǎn)流術(shù)在快速重建肢體血供中的應(yīng)用. 中國修復(fù)重建外科雜志, 2012, 26(2): 231-234. doi: 復(fù)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(xiàn)輝, 李燕山, 等. 顯微外科技術(shù)修復(fù)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(qiáng), 等. 四肢主要?jiǎng)用}鈍性損傷延誤修復(fù)的原因分析. 中華創(chuàng)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(yuǎn)林, 等. 動(dòng)脈臨時(shí)性橋接技術(shù)在四肢骨折合并血管損傷中的應(yīng)用. 中華創(chuàng)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(shù)在腫瘤切除術(shù)中的應(yīng)用. 山東醫(yī)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(bào)告. 中華創(chuàng)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. 1. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg, 2002, 10(6): 620-630.
  2. 2. 羅庚, 郭現(xiàn)輝, 李燕山, 等. 顯微外科技術(shù)修復(fù)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. 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. 4. 鄭燦鑌, 朱慶棠, 顧立強(qiáng), 等. 四肢主要?jiǎng)用}鈍性損傷延誤修復(fù)的原因分析. 中華創(chuàng)傷骨科雜志, 2011, 13(4): 392-394.
  5. 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. 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. 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. 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. 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. 10. Sriussadaporn S, Pak-art R. Temporary intravascular shunt in complex extremity vascular injuries. J Trauma, 2002, 52(6): 1129-1133.
  11. 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. 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. 13. 孫如泉, 劉澤, 張遠(yuǎn)林, 等. 動(dòng)脈臨時(shí)性橋接技術(shù)在四肢骨折合并血管損傷中的應(yīng)用. 中華創(chuàng)傷雜志, 2004, 20(9): 566-567.
  14. 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. 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. 16. 張澤峰, 徐振海, 姚繼方, 等. 心血管外科技術(shù)在腫瘤切除術(shù)中的應(yīng)用. 山東醫(yī)藥, 2005, 45(33): 32.
  17. 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. 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. 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(bào)告. 中華創(chuàng)傷骨科雜志, 2011, 13(5): 497-498.
  20. 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.