Loisel F, Pauchot J, Gasse N, Meresse T, Rochet S, Tropet Y, Obert L
Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, EA 4268 innovation, imagerie, ingénierie et intervention en santé I4S-IFR 133 Inserm, CHU Jean-Minjoz, université de Franche-Comté, Besançon, France.
Chir Main. 2010 Oct;29(5):326-31. doi: 10.1016/j.main.2010.03.007. Epub 2010 Apr 27.
Antithrombotic agents are not routinely used in microsurgery for finger replantation. A prospective monocentric study of 13 cases of replantation at hand level is reported with local irrigation of anastomosis with urokinase and low-molecular-weight heparin. Thirteen consecutive patients have been included and treated in the first six hours by three senior surgeons in microsurgery. The injuries consisted in one devascularisation of hand, two complete amputations of hand, four ring fingers and six complete amputations of finger. Crush injury was always pointed in case of amputation. During anastomoses, the arterial lumina were topically irrigated with 50,000 UI of urokinase and the venous lumina by 1.2 ml of Lovenox®. Bleeding was encouraged in case of digit replantation. In all cases, patients received Aspegic® 10mg/day and Fonzylane® three times per day for three weeks. Three failures have been reported and blood transfusion was necessary in one patient. The results showed that topical irrigation with urokinase and low-molecular-weight heparin or enoxaparin solution significantly reduced the thrombosis rate at the anastomosis site of the crushed arteries in clinical practice without uncontrolled adverse effect.
抗血栓药物在手指再植显微手术中并非常规使用。本文报告了一项前瞻性单中心研究，对手部水平的13例再植病例采用尿激酶和低分子肝素进行吻合口局部灌注。13例连续患者由三位资深显微外科医生在前六个小时内纳入并进行治疗。损伤包括1例手部血管离断、2例手部完全离断、4例环指离断和6例手指完全离断。截肢病例中均存在挤压伤。在吻合过程中，动脉腔局部用50,000国际单位尿激酶灌注，静脉腔用1.2毫升速碧林灌注。手指再植时鼓励出血。所有病例中，患者每天接受10毫克阿斯匹林和每天三次的氯苄噻唑啉，持续三周。报告了3例失败病例，1例患者需要输血。结果表明，在临床实践中，尿激酶与低分子肝素或依诺肝素溶液局部灌注可显著降低挤压动脉吻合口处的血栓形成率，且无失控的不良反应。
