下肢动脉血栓的机械性祛栓结合药物溶栓治疗  

Clinical study of mechanical thrombus extraction associated with medical treatment in lower extremity thrombosis

作　　者：虞希祥[1] 黄林芬[1] 胡哲[2] 南忆[1] 陈善锡[1] 司同国[1] 冯晓峰[1] 张叶敏[1] 

机构地区：[1]温州医学院附属第三医院介入科,浙江瑞安325200 [2]温州医学院附属第二医院放射科,浙江温州325000

出　　处：《中国临床医学影像杂志》2006年第11期640-643,共4页Journal of China Clinic Medical Imaging

基　　金：浙江省医药卫生优秀青年科技人才专项基金(2002QN016)。

摘　　要：目的:研究OASIS导管流变溶栓和Amplatz血栓消融导管(AmplatzThrombectomyDevice,ATD)浸软溶栓结合基因重组型人组织纤溶酶原激活剂(recombinanthumantissue-typeplasminogenactivator,rt-PA)或尿激酶(UK)药物溶栓治疗下肢动脉血栓形成的安全性和临床疗效。材料与方法:对18例下肢动脉血栓形成的患者实施急诊OASIS导管流变溶栓(12例)或ATD导管浸软溶栓(6例)术,对远端小血管残留血栓给予rt-PA溶栓2例,UK溶栓7例,对4例5处髂股动脉狭窄段采取经皮球囊扩张(PercutaneousTransLuminalAngioplasty,PTA)或支架成形辅助治疗。其中髂动脉3例,股动脉13例,腘动脉1例,股动脉、腘动脉、胫前胫后动脉及足部动脉广泛血栓形成1例。结果:18例机械性祛栓技术实施成功率100%,其中14例术中处理后立即完全再通;4例术后留置导管继续溶栓3～5天达到完全再通。其中4例5处动脉狭窄段采用球囊扩张或置入支架后狭窄段的血管腔平均复通率95%,临床表现好转率100%。全部病例均经DSA、B超及临床随访1～45个月,动脉均保持通畅。无血管穿孔并发症和截肢病例,溶栓过程中出现消化道出血1例。结论:采用OASIS导管和ATD导管机械性祛栓结合rt-PA或UK药物溶栓治疗能够快速地祛除下肢动脉血栓,安全性高,临床疗效显著。用PTA和支架辅助治疗可有效地解除动脉狭窄,防止血栓再形成,避免截肢。Objective： To study the safety and clinical therapeutic effect of Oasis catheter thrombolysis and Amplatz Thrombectomy Device（ATD） in the treatment of thrombosis in arteries of lower extremity combining recombinant human tissuetype plasminogen activator（rt-PA） or urokinase（UK）. Methods： Practise emergence operations were done with Oasis（12 cases） tube thrombolysis or ATD（6 cases） tube macerate thrombolysis for 18 patients suffering thrombosis of arteries of lower extremity, giving rt-PA thrombolysis （2 cases） and UK thrombolysis（7 cases） for distal end small vessels remaining thrombus. Pereutaneous transLuminal angioplasty （PTA） or stenting treatments were done for five segments of ilio-femur arteries in four patients. Among 18 patients, there are 3 iliac arteries, 13 femoral arteries, 1 popliteal artery, and 1 widespread thrombosis including femoral artery, popliteal artery, anterior and posterior tibial artery and ped-artery. Results： Technologic achievement ratio is 100% for the 18 cases. 14 cases completely recanalization immediately after treatment; 4 cases completely reeanalization afer continue thrombolysis for 3 to 5days by detaining catheter. In 4 cases with 5 stenosis arteries segments, recanalization rate is 95% after taking transLuminal angioplasty or steuts, clinical amelioration rate is 100%. The arteries of all cases remain open after 1 -45 months by DSA, B supersound and clinical following up. Without complication of vessels perforation and amputated extremity, only one case of digestive tract bleeding. Conclusion： Mechanical thrombolysis with Oasis or ATD catheters combining rt-PA or UK drugs can rapidly dissolved the thrombus of artery of lower extremity, with high safety and great clinical therapeutic effect. Using PTA and stems assistant treatment can effectively relieve stenosis of arteries, prevent reforming of thrombus and avoid amputation of lower extremity.

关 键 词：血栓形成 动脉闭塞性疾病 放射学 介入性 

分 类 号：R543.5[医药卫生—心血管疾病] R815[医药卫生—内科学]