准分子激光消蚀联合药物涂层球囊治疗下肢动脉硬化闭塞20例  

Excimer laser ablation combined with drug-coating balloon angioplasty for lower extremity arteriosclerosis occlusive diseases: preliminary results in 20 patients

作　　者：谷涌泉[1] 郭连瑞[1] 齐立行[1] 崔世军[1] 郭建明[1] 李杨[1] 高喜翔[1] 佟铸[1] 齐一侠[1] 张成超[1] 吴中俭 杨盛家[1] 张建[1] 汪忠镐[1] GU Yongquan;GUO Lianrui;QI Lixing;CUI Shijun;GUO Jianming;LI Yang;GAO Xixiang;TONG Zhu;QI Yixia;ZHANG Chengchao;WU Zhongjian;YANG Shengjia;ZHANG Jian;WANG Zhonggao(Department of Vascular Surgery,Xuanwu Hospital,Capital Medical University,Vascular Surgery Institute of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管外科、首都医科大学血管外科研究所,北京100053

出　　处：《介入放射学杂志》2018年第8期779-782,共4页Journal of Interventional Radiology

基　　金：北京市医管局临床技术创新项目(XMLX201610);北京市医管局“登峰”人才计划项目(DFL20150801); 北京市优秀人才项目(2016000020124G108); 北京市科委“首都临床特色应用研究”专项项目(Z141107002514063); 北京市卫生系统高层次卫生技术人才培养计划项目(2014-3-059); 首都卫生发展科研专项项目(2016-1-2012); 北京市属医院科研培育计划项目(PX2018035); 首都医科大学宣武医院“英才培养计划”项目

摘　　要：目的评价准分子激光消蚀术(ELA)联合药物涂层球囊治疗下肢动脉硬化闭塞的安全性和有效性。方法回顾性分析2016年11月至2017年6月收治的20例接受ELA联合药物涂层球囊治疗的下肢动脉硬化闭塞患者临床资料。结果手术成功19例(95%),症状消失,静息痛症状缓解;失败1例(伴发腹主动脉瘤、静息痛),瘤腔内大量血栓多次脱落至远端动脉,足部动脉完全闭塞,且取栓后效果不佳,终因剧烈疼痛予膝下截肢。1例前半足截肢患者于术后第7日左下肢动脉形成血栓,经溶栓后症状有所缓解。术后踝-肱指数(ABI)与术前比较,7例(36.8%)提升<0.3,8例(42.2%)提升0.3~0.5,4例(21.0%)提升>0.5。18例患者平均随访4(1~8)个月,症状均缓解,未再次干预;1例足趾溃疡患者溃疡愈合。结论ELA联合药物涂层球囊治疗下肢动脉硬化闭塞所致缺血安全、有效,但仍需更大样本量和更长随访时间临床观察。Objective To evaluate the efficacy and safety of excimer laser atherectomy（ELA）combined with drug-coating balloon angioplasty in treating lower extremity arteriosclerosis occlusive diseases.Methods The clinical data of 20 patients with chronic ischemia caused by arteriosclerosis occlusive diseases of lower limbs, who were admitted to authors＇ hospital to receive ELA therapy during the period from November 2016 to June 2017, were retrospectively analyzed. Results Successful ELA was accomplished in19 patients（95%）, their clinical symptoms disappeared and the symptoms of resting pain were improved. ELA procedure failed in one patient, who had abdominal aortic aneurysm and resting pain; the great quantity of thrombus within the aneurysmal lumen repeatedly fell off and floated to distal arteries, and the patient＇s foot arteries were completely occluded; finally, as the effect of thrombus removal treatment was poor, below-knee amputation had to be carried out due to unbearable severe pain. Another patient, who had received anterior half foot amputation, developed thrombosis of left lower extremity artery on the seventh day after ELA therapy, the clinical symptoms were relived to some extent after thrombolytic therapy. Compared with preoperative data, the postoperative ankle-brachial index（ABI） was improved; an increase of 0.3 was seen in 7 patients（36.8%）, an increase of 0.3-0.5 in 8 patients（42.2%）, and an increase of 0.5 in 4 patients（21.0%）. Eighteen patients were followed up for a mean of 4 months（1-8 months）, the clinical symptoms were improved in all patients, no second intervention therapy was needed, and the skin ulcer healed up in one patient who had toe ulceration. Conclusion For the treatment of arteriosclerosis occlusive diseases of lower limbs, ELA combined with drug-coating balloon angioplasty is safe and effective, although more researches with large sample and long-term clinical follow-up observation are needed to further clarify its curative effect.

关 键 词：动脉闭塞性疾病 下肢 准分子激光消蚀术 经皮腔内血管成形术 

分 类 号：R528.1[医药卫生—内科学]