导管接触溶栓与手动经导管抽吸血栓清除术治疗急性肢体缺血临床效果对比  

Catheter-directed thrombolysis versus manual percutaneous aspiration thrombectomy for the treatment of acute limb ischemia: comparison of the clinical efficacy

作　　者：王剑 顾建平[2] 高立兵 公茂峰 钱成 刘亮 汪涛[2] 倪国庆 陈国平[2] WANG Jian;GU Jianping;GAO Libing;GONG Maofeng;QIAN Cheng;LIU Liang;WANG Tao;NI Guoqing;CHEN Guoping(Department of Medical Imaging,Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 211100,China)

机构地区：[1]南京医科大学附属江宁医院医学影像科,211100 [2]南京医科大学附属南京医院(南京市第一医院)介入血管科

出　　处：《介入放射学杂志》2021年第10期1029-1034,共6页Journal of Interventional Radiology

基　　金：南京医科大学科技发展基金一般项目(NMUB2019144、NMUB2019158)。

摘　　要：目的比较导管接触溶栓(CDT)和手动经导管抽吸血栓清除术(mPAT)治疗急性肢体缺血(ALI)技术成功率和临床疗效。方法回顾性分析2014年2月至2018年12月在两中心接受CDT或mPAT作为首选方法治疗的73例ALI患者临床资料,其中CDT组41例(41条患肢),mPAT组32例(33条患肢)。观察两种治疗方法的技术成功率、并发症发生率、30 d内临床疗效、术后及随访期患肢踝-肱指数(ABI)值、术后1年保肢率和无截肢生存率。结果 CDT组、mPAT组初始技术成功率分别为51.2%(21/41)、27.3%(9/33)(P=0.037),分别有11条、17条患肢辅助其他血管内技术,技术成功率分别提高至78.0%(32/41)和78.8%(26/33)(P=0.939);术中发生动脉夹层并发症分别为0例和4例(13.8%)(P=0.036);术后患肢平均ABI值分别为0.72±0.08、0.72±0.10,较术前0.31±0.11、0.32±0.08均有显著改善(P<0.05),随访12个月内均保持稳定(P>0.05);临床有效率分别为85.4%(35/41)、81.8%(27/33)(P=0.681),其中亚组RutherfordⅡb级患者临床有效率分别为54.5%(6/11)、70.6%(12/17)(P=0.644);Kaplan-Meier生存分析显示,12个月保肢率分别为92.7%、90.9%(P=0.767)。结论 CDT和mPAT作为首选方法治疗ALI的临床疗效相似。CDT初始技术成功率高于mPAT,初次mPAT后多数患者需要辅助其他血管内技术。mPAT术中可能发生动脉夹层并发症需引起重视。Objective To compare the technical success rate and clinical efficacy of catheter-directed thrombolysis(CDT) with those of manual percutaneous aspiration thrombectomy(m PAT) in treating acute limb ischemia(ALI). Methods The clinical data of 73 ALI patients, who received CDT(CDT group, n=41, 41 diseased limbs in total) or mPAT(mPAT group, n=32, 33 diseased limbs in total) at two medical centers between February 2014 and December 2018, were retrospectively analyzed. The technical success rate,incidence of complications, postoperative 30-day clinical efficacy, postoperative and follow-up ankle-brachial index(ABI) values of diseased limb, and postoperative one-year limb salvage rate and amputation-free survival rate were compared between the two groups. Results The initial technical success rates in CDT group and mPAT group were 51.2%(21/41) and 27.3%(9/33) respectively(P<0.037). Additional endovascular technique was adopted in 11 patients of CDT group and 17 patients of mPAT group, and the technical success rates in CDT group and mPAT group were increased to 78.0%(32/41) and 78.8%(26/33) respectively(P=0.939). In CDT group and mPAT group, arterial dissection during operation occurred in 0 patient and 4 patients(13.8%)respectively(P=0.036);postoperative mean ABI values of diseased limb were(0.72±0.08) and(0.72±0.10)respectively, which were significantly better than preoperative(0.31±0.11) and(0.32±0.08) respectively(P<0.05) and which kept stable during 12-month follow-up period;the clinical efficacy was 85.4%(35/41)and 81.8%(27/33) respectively(P=0.681), among them the clinical efficacy of Rutherford Ⅱb patients was54.5%(6/11) and 70.6%(12/17) respectively(P=0.644);and Kaplan-Meier survival analysis showed that postoperative one-year limb salvage rates were 92.7% and 90.9% respectively(P=0.767). Conclusion As the preferred treatments for ALI, CDT and mPAT have quite similar clinical efficacy. The initial technical success rate of CDT is higher than that of mPAT. Assistance of additional endovascular technique i

关 键 词：急性下肢缺血 动脉栓塞 动脉血栓形成 导管接触溶栓 经导管抽吸血栓清除术 

分 类 号：R543.6[医药卫生—心血管疾病]