超声引导下Fogarty球囊导管在动脉危象中的临床应用  

Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis

作　　者：李小东[1] 王培[1] 于昌玉[1] 严晓薇[2] 尹晶[3] 

机构地区：[1]承德医学院附属医院手足外科,河北承德067000 [2]承德医学院附属医院重症医学科,河北承德067000 [3]承德医学院附属医院血管外科,河北承德067000

出　　处：《中国修复重建外科杂志》2017年第10期1220-1224,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：2016年度河北省卫生厅指令性项目(20160010)~~

摘　　要：目的观察超声引导下Fogarty球囊导管在断肢再植术后动脉危象中应用的临床疗效。方法 2012年1月—2016年7月,应用超声引导下Fogarty球囊导管联合溶栓抗凝药物治疗断肢再植术后动脉危象患者27例。男18例,女9例;年龄19~51岁,平均32岁。膝关节离断3例,小腿离断9例,踝关节离断6例,肘关节离断2例,前臂离断4例,腕关节离断3例。于断肢再植术后2.5~18 h,平均7.5 h出现动脉危象。均采用彩色多普勒超声检查明确诊断,其中吻合口血栓16例,非吻合口血栓7例,联合血栓4例。血栓均存在于动脉内,长度为0.8~3.9 cm。结果术后患者均未发生血管穿孔、破裂、空气栓塞、血栓栓塞、伤口感染及败血症等并发症。术后1.5~13.5 h 3例再次出现动脉危象,行切开探查术,1例治疗成功;2例动脉闭塞,肢体部分坏死,行截肢术。余24例患肢顺利成活,切口均Ⅰ期愈合,其中1例出现急性肌病肾病代谢综合征,予以血液透析后得以纠正;1例出现急性肝功能损害,予以内科综合治疗纠正。24例患者获随访7~38个月,平均11个月。末次随访时肢体血运良好,皮温正常,感觉、活动度及肿胀度均改善。参照中华医学会手外科学会上肢部分功能评定试用标准评价疗效,获优12例、良8例、差4例,优良率83.3%。结论超声引导下应用Fogarty球囊导管处理断肢再植术后动脉危象,血栓定位精准,取栓快捷、微创,避免了盲目、反复取栓,临床疗效肯定。Objective To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years （mean, 32 years）. The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours （mean, 7.5 hours） after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months （mean, 11 months）. At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in

关 键 词：彩色多普勒超声 FOGARTY球囊导管 断肢再植 动脉危象 

分 类 号：R658.1[医药卫生—外科学]