Smith C, Green R M
Surgery. 1981 Jul;90(1):20-31.
The literature on the treatment of pediatric vascular injuries was reviewed. Aggressive treatment of arterial ischemia is clearly indicated, since children with uncorrelated arterial thrombosis are almost certain to develop a growth abnormality in the affected extremity. Alternatives to operative treatment have not been well described. Operative treatment is technically difficult and results are strongly influenced by age. To emphasize this relationship, we combined 10 cases of arterial thrombosis treated operatively in children under age 2 years complied form the literature with five similar cases reviewed retrospectively in our hospital. In these 15 patients the etiology was iatrogenic in 100%. Sixty-seven percent (10 of 15) were treated with simple thrombectomy, and only one patient (7%) received a graft. At up to 8 years of follow-up, only 26% (3 of 15) were normal, 47% (7 of 15) had thrombosis, 20% (3 of 15) had suffered tissue loss, and there had been one perioperative death. We conclude that operative treatment of an ischemic although viable limb in a small child might best be deferred if simple thrombectomy has failed or if a more complex procedure would be required at the outset, with the hope that any growth abnormality that developed could be reversed by definitive reconstruction when the child is larger.
我们回顾了有关小儿血管损伤治疗的文献。对于动脉缺血进行积极治疗显然是必要的，因为患有不相关动脉血栓形成的儿童几乎肯定会在受影响的肢体出现生长异常。非手术治疗方法尚未得到充分描述。手术治疗在技术上具有难度，且结果受年龄的影响很大。为强调这种关系，我们将文献中报道的10例2岁以下儿童接受手术治疗的动脉血栓形成病例与我院回顾性分析的5例类似病例进行了合并。在这15例患者中，病因100%为医源性。67%（15例中的10例）接受了单纯血栓切除术，只有1例患者（7%）接受了血管移植。随访长达8年时，只有26%（15例中的3例）恢复正常，47%（15例中的7例）出现血栓形成，20%（15例中的3例）发生了组织缺失，并且有1例围手术期死亡。我们得出结论，如果单纯血栓切除术失败或一开始就需要更复杂的手术，对于小儿缺血但仍存活的肢体，手术治疗最好推迟，希望当孩子长大后，任何出现的生长异常能够通过确定性重建得到纠正。
