机械血栓清除术在急性下肢缺血治疗中的应用价值  

Percutaneous mechanical thrombectomy for the treatment of acute limb ischemia

作　　者：陈书肖 罗坤 陈剑峰 卞帅 夏林述鑫 张汝铭 封学栋 高培显[1] 李刚[1] 吴学君[1] Chen Shuxiao;Luo Kun;Chen Jianfeng;Bian Shuai;Xialin Shuxin;Zhang Ruming;Feng Xuedong;Gao Peixian;Li Gang;Wu Xuejun(Department of Vascular Surgery,Provincial Hospital,Shandong University,Jinan 250021,China;Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院血管外科,济南250021 [2]山东第一医科大学,济南250021

出　　处：《中华普通外科杂志》2021年第5期346-349,共4页Chinese Journal of General Surgery

摘　　要：目的:评价机械血栓清除术治疗急性下肢缺血的临床效果。方法:回顾性分析2017年6月至2019年9月经Rotarex机械血栓切除系统治疗的50例下肢缺血患者的临床资料。结果:术中腘动脉破裂4例,技术成功率为92%。7例辅以导管接触性溶栓治疗;4例采用经皮血管腔内成形术;39例采用经皮血管腔内成形术联合支架植入术。手术前后50例患者的踝肱指数分别为0.18±0.24和0.64±0.28(t=12.87,P<0.001)。43例获得临床成功。随访的1~24个月内,截肢5例;足趾溃疡坏疽未好转2例;血栓复发9例;未观察到出血等并发症。术后3、6、12个月一期通畅率分别为92%、84%、74%。结论:机械血栓切除系统治疗急性下肢缺血是安全、有效的,具有较理想的短期通畅率。Objective To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results In 4 cases of popliteal artery rupture occurred during the operation.The success rate of the operation was 92%.Catheter-directed thrombolysis was used in 7 cases,percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases.The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively(t=12.87,P<0.001).Treatment was successful in 43 cases.Follow-up ranged from 1 to 24 months,5 cases were amputated,2 cases had no improvement of toe ulcer gangrene,9 cases had thrombus recurrence,and no complications such as bleeding were observed.The primary patency rates at 3,6 and 12 months were 92%,84%and 74%,respectively.Conclusion The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

关 键 词：动脉闭塞性疾病 血管外科手术 下肢 

分 类 号：R654.4[医药卫生—外科学]