下肢动脉缺血性疾病的杂交治疗  

Hybridization Therapy of Ischemic Diseases in the Lower Extremities

作　　者：张智辉[1] 林少芒[1] 萧剑彬[1] 曹良启[1] 

机构地区：[1]广州医学院第二附属医院血管外科,广东广州510260

出　　处：《临床医学工程》2012年第1期39-41,共3页Clinical Medicine & Engineering

基　　金：广东省科技计划项目"血管镜联合腔内技术在下肢缺血性疾病的应用研究"(№2008B060600047);广州市卫生局立项课题"下肢缺血性疾病的腔内治疗策略与临床路径实施"(编号:2008-YB-168)

摘　　要：目的探讨下肢动脉缺血性疾病杂交治疗的临床价值。方法收集我院自2008年3月至2011年3月期间70例(86条肢体)下肢动脉缺血患者病人资料,根据患肢的不同情况,应用血管镜直视下判断是否合并血栓,灵活组合应用球囊取栓、术中造影、球囊扩张和(或)支架成形术、人工血管旁路术等杂交手术方法;配合截肢(趾)术、局部清创术、持续负压引流术(vacuum sealing draina,VSD)、特殊敷料换药等各种治疗措施。结果血管镜下发现并取出血栓45例,其中41例髂股动脉合并不同程度狭窄需同时进行腔内治疗,25例没有发现血栓或血管镜无法进入直接行腔内治疗或旁路手术治疗。患者术后疼痛缓解率为97.5﹪,1个月溃疡愈合率为87.8%;术后1年通畅率为86%,围手术期死亡2例。所有病例术后一周症状均得到缓解。结论下肢动脉缺血性疾病病情复杂多样,需进行个体化评估,采取外科和腔内杂交一站式灵活多样方法进行治疗,效果满意,值得临床推广。Objective To investigate clinical application value of hybridization therapy of ischemic diseases in the lower extremities. Methods 70 cases （including 86 limbs） of clinical dams from patients with ischemic diseases in the lower extremities in our hospital from March 2008 to March 2011 were randomly collected and analysed. Vascular endoscopy was firstly used to check whether laid in thrombus in the lower extremities vessel. Then, intraoperation radiography, balloon thrombectomy and dilatation, stent placement and plasty, bypass operation of artificial vessel were sequently performed. Moreover, amputation, local debridement, vacuum sealing drainage （VSD）, and special change fresh dressing for wounds were combined to apply necessarily. Results Thrombectomy of 45 cases was completed by vascular endoscopy. Intracavity repair was performed in 41 cases of the patients for endovascular stricture, and bypass operation with 25 cases. Pain remission rate at the postoperation was 97.5%, ulcer healing rate in one month was 87.8%, and patency rate in one year was 86%. Unfortunately, 2 patients died of multiple organs failure at the perioperative period. The symptoms in all cases remitted after surgery a week later. Conclusion Lower limb artery ischemic diseases are diverse and complex, and the individual assessment is necessary. Hybridization therapy is effectively and safely used to treat ischemic diseases in the lower extremities, which is worth generalizing in the clinical practice.

关 键 词：缺血性疾病 血管镜 杂交治疗 

分 类 号：R543.5[医药卫生—心血管疾病] R323.72[医药卫生—内科学]