AngioJet机械血栓抽吸技术在动脉栓塞及血栓形成中的应用体会  

Experience of Angio Jet mechanical thrombectomy treatment on acute arterial embolism

作　　者：张雷[1] 陆清声[1] 裴轶飞[1] 王宏飞[1] 袁良喜[1] 魏小龙[1] 冯家烜[1] 李海燕[1] 毛华娟[1] 景在平[1] 

机构地区：[1]上海第二军医大学附属长海医院血管外科,上海200433

出　　处：《中国血管外科杂志（电子版）》2016年第3期203-207,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金青年项目(81200225);第二军医大学青年基金(2010QN11);长海医院"1255"科研探索项目(CH125541200);长海医院卫勤分队课题基金(WQ2015015)

摘　　要：目的总结Angio Jet机械血栓抽吸+喷药溶栓治疗急性动脉栓塞(AE)经验和体会。方法回顾分析2013年12月至2015年4月上海长海医院收治急性期AE患者行Angio Jet机械血栓抽吸39例(锁骨下动脉3例,腹主动脉2例,肱动脉1例,下肢动脉33例)临床资料,通过观察临床症状改善情况和术中造影结果来评价动脉复通效果。随访内容包括临床症状、体征的评估和下肢动脉多普勒超声检查。结果 39例患者均完成溶栓和吸栓,平均住院日(4.3±1.5)天,平均手术时间(1.3±0.4)小时,喷药溶栓33例,后续置管溶栓6例,动脉切开取栓2例。即时技术成功31例(79.5%),配合置管溶栓及球囊扩张和/或支架成形术后技术成功37例(94.9%)。并发症包括足趾端发黑6例,穿刺点渗血5例。34例患者术后血色素均有不同程度下降,平均降低(7.6±2.7)g/L,15例患者出现不同程度的肌红蛋白尿。随访至少1年提示下肢动脉通畅32例,3例患者再次出现肢体缺血症状。结论 Angio Jet是一种安全有效的机械血栓抽吸装置,较传统动脉置管溶栓有部分优势,但需配合传统置管溶栓和支架成形术。短期疗效较满意,但远期效果待研究。Objective To summarize the experience of Angiojet mechanical thrombectomy for the treatment of acute arterial embolism （AE）. Methods Clinical data of 39 patients with acute AE treated by Angiojet mechanical thrombectomy during December 2013 and April 2015 were analyzed retrospectively. Clinical symptom was graded based on pre- and post-treatment angiography.Follow-up was performed by Doppler ultrasound and clinical evaluation. Results All the patients received mechanical thrombectomy with Angiojet. The average length of hospitalization was （4.3 ±1.5） days. The average operation time was （1.3±0.4） hours. Thirty three patients were treated with Angiojet thrombolysis, which failed in 6 patients who subsequently received catheter-directed thrombolysis （CDT）. Immediate technique success rate was 19.5%. However, after percataneoustransluminal angioplasty and bare stents implantation to treat arterial stenosis, a technique success rate of 94.9% was achieved. The average reduction of hemoglobin was （7.6 ± 2.7）g/L. Fifteen patients had myoglobinuria to different extent. During follow-up of more than one year, the treated lesions remained patent in 32 patients. Three patients had reoccurence of limb ischemia. Conclusion Angiojet is safe and effective for treating acute AE with or without angioplasty. The short-term follow-up is satisfactory, when long-term follow-up is needed.

关 键 词：动脉栓塞 急性 吸栓 溶栓 血管成形术 

分 类 号：R654.4[医药卫生—外科学]