腔内介入术治疗急性肱动脉损伤的疗效  

Efficacy of endovascular interventional minimally invasive techniques in treatment of acute brachiai artery injury

作　　者：张希全 葛世堂 陈众 董戈 郭峰 

机构地区：[1]解放军第一四八医院全军腔内介入诊疗中心,淄博255300

出　　处：《中华创伤杂志》2017年第3期281-284,共4页Chinese Journal of Trauma

基　　金：军队后勤科研计划（CJN14J010）

摘　　要：目的探讨腔内介入术治疗急性肱动脉损伤的疗效。方法采用回顾性病例系列研究分析2011年3月-2016年8月收治的16例急性肱动脉损伤患者资料，其中男11例，女5例；年龄27～66岁，平均47．9岁。损伤血管部位：左上肢7例，右上肢9例。损伤类型：动脉内膜损伤13例，假性动脉瘤3例。应用腔内介入技术，实施支架置入及球囊扩张治疗。采用造影评估肱动脉血流恢复情况；记录手术时间；观察患肢远端动脉搏动及肢体缺血症状改善情况；随访观察支架阻塞情况，支架内再狭窄〉50％者再行介入治疗；观察术后并发症发生情况。结果16例患者均成功完成手术，手术时间为30—75min，平均45min。置入支架后造影显示损伤肱动脉血流恢复通畅，假性动脉瘤消失，未见支架狭窄及对比剂外溢。术后局部疼痛、麻木等症状缓解，远端供血恢复好转，患侧肱动脉及桡动脉恢复强有力动脉搏动。患者均获随访3～36个月，平均16．7个月。3例假性动脉瘤未复发。2例术后支架内再狭窄〉50％，再行球囊扩张后血流恢复通畅；14例支架通畅（再狭窄率〈50％）。无一例患者出现缺血坏死、支架移位或断裂等并发症。结论腔内介入术治疗急性肱动脉损伤技术成功率高，并发症少，疗效满意。Objective To evaluate the efficacy of endovascular interventional minimally invasivc techniques in treatment of acute brachial artery injury. Methods A retrospective case series study was designed to analyzed data of 16 cases （11 males and 5 females） sustaining acute brachial artery injury treated from March 2011 to August 2016. Mean age was 47.9 years （range, 27-66 years）. Left upper extremity vascular injury occurred in 7 cases and right upper extremity vascular injury occurred in 9. There were 13 cases of arterial intima injury and 3 of arterial pseudoaneurysm. All patients underwent endovaseular therapy including stent implantation and balloon dilatation. Angiography was used to evaluate the repair of brachial artery and the operation time was recorded. Improvements of distal limb arterial pulse and limb ischemic symptoms were observed, and the patients who were followed up with stent lumen stenosis more than 50% received endovascular treatment again. Results The procedures was successful in all patients, with operation time of 30-75 minutes （mean, 45 minutes）. After the insertion of a stent, recovered brachial artery blood flow and disappeared pseudoaneurysm were observed on angiography, without occurrence of stent stenosis or contrast extravasation. Symptoms of local pain and numbness were alleviated, and blood supply of the distal brachial artery was improved after operation. All patients were followed up for 3-36 months （mean, 16.7 months）. The false aneurysm did not recur. Two cases of stent stenosis more than 50% had a second balloon dilation procedure and the blood flow returned to normal. Stent patency was found in 14 cases with stent stenosis of less than 50%. During the follow-up period, noischemic necrosis, displacement of the stent or stent fracture were found. Conclusion For acute braehial artery injury, endovascular management exhibits higher technical success rate and good clinical outcome with a low incidence of complications.

关 键 词：肱动脉 支架 血管系统损伤 

分 类 号：R654.4[医药卫生—外科学]