AngioJet机械血栓抽吸术治疗急性下肢动脉栓塞及血栓形成的临床疗效观察  

Clinical efficacy of AngioJet mechanical thrombectomy for the treatment of acute lower extremity arterial embolism and thrombosis

作　　者：牛启兵[1] 陈泉[1] 温世奇[1] 李安强[1] 董方[1] 史浩[1] 孙万里[1] NIU Qibing;CHEN Quan;WEN Shiqi;LI Anqiang;DONG Fang;SHI Hao;SUN Wanli(Department of Vascular Surgery,Peopled Hospital in Gansu Province,Lanzhou 730000,P. R. China)

机构地区：[1]甘肃省人民医院血管外科

出　　处：《中国普外基础与临床杂志》2019年第8期949-953,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨急性下肢动脉栓塞及血栓形成患者行AngioJet机械血栓抽吸术治疗的临床效果。方法回顾性分析2016年9月至2017年3月期间笔者所在医院血管外科收治的20例急性下肢动脉栓塞及血栓形成患者的临床资料,患者均接受AngioJet机械血栓抽吸手术治疗,总结其治疗效果。结果20例患者中,18例患者完成吸栓治疗,技术成功率为90.0%,其住院持续时间为(4.2±1.4)d,手术过程持续时间为(1.3±0.4)h,在手术过程中的尿激酶药物使用剂量为(35.80±12.30)×10^4U,肝素药物的使用剂量为(45.10±8.30)mg。2例改为切开取栓。2例吸栓后继续置管溶栓治疗,5例吸栓后行球囊扩张及置入金属裸支架。术后临床成功16例。采用Cooley标准评估疗效:痊愈10例,良好6例,一般2例,较差2例。术中出现远端动脉栓塞2例,出现心动过缓心前区不适感2例,穿刺点渗血4例,但无消化道、颅内出血等严重出血并发症发生。术中及术后共16例患者出现肌红蛋白尿。术后所有患者接受随访,随访时间为6~12个月。超声检查结果显示:动脉通畅15例;1例于术后9个月死于心肌梗塞,2例术后再次出现下肢缺血症状,2例有下肢缺血症状导致的下肢溃疡;其余患者随访期间无下肢坏死、无截肢且无死亡。结论AngioJet是一种安全有效的机械血栓抽吸装置,但仍需配合传统置管溶栓和支架成形术,可快速恢复下肢血流灌注,提高保肢率,有较好的临床应用价值。Objective This study was aimed to evaluate the clinical efficacy of mechanical thrombectomy using the AngioJet System for the treatment of lower extremity acute arterial embolism and thrombosis. Methods The clinical data of 20 patients with acute lower extremity arterial embolism and thrombosis admitted to the Department of Vascular Surgery in the People’s Hospital in Gansu Province where the author worked from September 2016 to March 2017, were retrospectively analyzed. All patients were treated with the AngioJet mechanical thrombectomy system.Clinical data of the patients were retrospectively collected. The clinical efficacy of AngioJet mechanical thrombectomy was analyzed. Results Eighteen(90.0%) of the 20 patients successfully completed the mechanical thrombectomy by using the AngioJet System. The mean time for hospital stay and operation was(4.2±1.4) d and(1.3±0.4) h, respectively. The average doses of urokinase and heparin during operation were(35.80±12.30) ×10^4 U and(45.10±8.30) mg, respectively. Two patients received a complementary treatment of incision for removing the thrombus. Two patients received catheterdirected thrombolysis after the mechanical thrombectomy, 5 patients received bare-metal stent implantation after balloon expansion. Clinical success was in 16 cases. According to the Cooley standard, 10 patients were in excellent condition,6 in good condition, 2 in fair condition, and 2 in poor condition. There were 2 cases of distal arterial embolization,2 cases of antecardial discomfort of bradycardia, and 4 cases of bleeding at the puncture point, but no serious bleeding complications such as gastrointestinal and intracranial hemorrhage occurred. A total of 16 patients presented myoglobinuria during and after operation. All patients were followed up for 6–12 months. The results of ultrasound examination showed that the artery was patency in 15 cases. One patient died of myocardial infarction in 9 months after surgery,2 patients developed lower extremity ischemia symptoms again after sur

关 键 词：急性下肢动脉栓塞 急性下肢血栓形成 AngioJet机械血栓抽吸 支架置入 

分 类 号：R654.4[医药卫生—外科学]