急性肢体缺血的治疗选择:附15例报告  

Treatment options for acute limb ischemia:a report of 15 cases

作　　者：李南[1] 陈幸生[1] 官云彪[1] 薛明[1] 洪登科[1] 

机构地区：[1]福建医科大学附属协和医院血管外科,福建福州350000

出　　处：《中国普通外科杂志》2014年第6期747-750,共4页China Journal of General Surgery

基　　金：国家临床重点专科建设基金资助项目[闽财指(2012)966号]

摘　　要：目的:探讨急性肢体缺血(ALI)治疗策略的选择。方法:回顾性分析2012—2013年期间收治的15例ALI患者的临床资料。结果:患者在治疗前均接受急性肢体缺血情况评估。其中,栓塞性病因11例,血栓形成性4例;主、髂动脉病变9例,股浅动脉病变3例,腘动脉、小腿动脉、肱动脉病变各1例;肢体缺血分级IIa级1例,IIb及12例,III级2例。除1例因拒绝一期截肢行单纯药物治疗外,14例均行血管再通治疗,其中,手术取栓11例,腔内溶栓2例,"杂交"治疗1例。住院期间无死亡,截肢2例,再灌注损伤3例,无行骨筋膜室切开者,平均住院天数9(3～27)d。平均随访时间9(1～21)个月,死亡3例(20.0%),无新发截肢者,保肢率66.7%(10/15)。结论:准确的缺血情况评估、并及时选择恰当的血管再通方式,是治疗ALI的关键。Objective： To investigate the options of treatment strategy for acute limb ischemia （ALI）. Methods： The clinical data of 15 patients with ALI, treated from 2012 to 2013, were retrospectively analyzed.Results： ALI patients underwent evaluation of the severity of acute limb ischemia before treatment. Of the patients, 11 cases were caused by embolism and 4 cases were caused by thrombosis; 9 cases had an aortic or lilacartery occlusion, 3 cases had superficial femoral artery occlusion, and one case each had a lesion in the popliteal aftery, artery of the lower leg and brachial artery, respectively; limb ischemia in one case was classified as grade Ⅱa,12 cases were grade Ⅱb, and 2 cases were grade Ⅲ. All the patients, except one who refused primary amputation and received drug treatment only, underwent urgent revascularization that included surgical embolectomy in 11 cases, endovascular thrombolysis in 2 cases, and hybrid procedure in one case. During their hospital stay, no death occurred, amputation was performed in 2 cases, reperfusion injury developed in 3 cases but fasciotomy was notrequired in any of them, and the median length of hospital stay was 9 （3-27） d. During a mean follow-up periodof 9 （1-21） months, 3 patients （20%） died, and no additional amputation was performed. The total limb salvage rate was 66.7%.Conclusion： Accurate evaluation of severity ofischemia, and prompt and appropriate revascularization procedureare crucial for treatment of ALI.

关 键 词：动脉闭塞性疾病 外科学 四肢 缺血 急性 

分 类 号：R654.3[医药卫生—外科学]