导管接触溶栓治疗四肢非开放性外伤后动脉血栓形成  

Catheter-directed thrombolysis for arterial thrombosis after non-open extremity injury

作　　者：赵堂海[1] 郭明金[1] 解远峰[1] 战激光[1] 张杰[1] 逄晓军[1] 秦少华[1] 

机构地区：[1]中国人民解放军第一0七医院血管外科,山东烟台264002

出　　处：《中国普通外科杂志》2014年第6期751-754,共4页China Journal of General Surgery

摘　　要：目的:探讨应用导管接触溶栓(CDT)治疗四肢外伤(非开放性)后动脉血栓形成的临床效果。方法:回顾性分析2005年3月—2013年3月收治的152例四肢外伤后动脉血栓形成行CDT治疗患者(152条肢体)的临床资料。患者均接受CDT治疗,其中单纯CDT 89例,CDT+腔内球囊扩张成形(PTA)51例,CDT+PTA+支架置入12例。结果:全组导管溶栓时间为1～7 d,平均(4±1.5)d。治愈105例(69.1%),其中单纯CDT 72例,CDT+PTA 21例,CDT+PTA+支架置入12例;有效30例(19.7%),均施行CDT+PTA治疗;无效17例(11.2%),其中一期截肢15例(9.9%)。5例(3.3%)溶栓过程中发生二次栓塞,调整导管位置后继续溶栓;23例(15.1%)术后发生小腿骨筋膜室综合征行骨筋膜室切开减压术,均保肢成功。随访132例(86.8%),随访时间12～108个月,平均(50±22)个月。除2例行二期截肢外,余随访患者均无症状加重或复发。结论:CDT治疗四肢外伤后动脉血栓形成是一种安全、有效、微创的方法。Objective： To evaluate the clinical efficacy of catheter-directed thrombolysis （CDT） for arterial thrombosis after extremity injury （non-open injuries）.Methods： The clinical data of 152 patients （152 limbs） with arterial thrombosis secondary to extremity injury admitted from March 2005 to March 2013 undergoing CDT treatment were retrospectively analyzed. All patientsreceived CDT treatment that included CDT alone in 89 cases, CDT plus percutaneous transluminal angioplasty （PTA） in 51 cases, and CDT plus PTA with stent placement in 12 cases.Results： The CDT treatment time in the entire group ranged from 1 to 7 d with an average time of （4±1.5） d. One-hundred and five patients （69.1%） were cured, of whom 72 cases underwent CDT alone, 21 casesunderwent CDT plus PTA, and 12 cases underwent CDT plus PTA with stent placement; 30 patients （19.7%）were improved and all of them underwent CDT plus PTA, while 17 patients （11.2%） were unimproved, of whom, primary amputation was performed in 15 cases （9.9%）. A secondary embolization occurred in 5 patients duringthrombolysis and they underwent thrombolysis therapy again after adjustment of the catheter position, and 23 patients （15.196） underwent fasciotomy due to compartment syndrome of lower leg and their legs were salvaged.One-hundred and thirty-two patients （86.8%） were followed-up for 12 to 108 months, with an average time of （50±22） months. Except for 2 cases who were subiected to a two-stage amputation, no worsening or recurrenceof the symptoms was noted in any of the follow-up patients. Conclusion： CDT is a safe, effective and minimally-invasive treatment method for arterial thrombosis afterextremity injury.

关 键 词：血栓形成 动脉闭塞性疾病 继发性 四肢 创伤和损伤 血栓溶解疗法 

分 类 号：R654.4[医药卫生—外科学]