医源性与非医源性血管内异物的取出策略与方法:附15例报告  

Strategies and methods for retrieval of iatrogenic and noniatrogenic intravascular foreign bodies: a report of 15 cases

作　　者：陈小彬 黄春银 林晨 游悦楷[3] 戴天增[3] 黄建强 黎成金 郑凡 陈剑伟 CHEN Xiaobin;HUANG Chunyin;LIN Chen;YOU Yuekai;DAI Tianzeng;HUANG Jianqiang;LI Chengjin;ZHENG Fan;CHEN Jianwei(Department of Vascular Surgery,the 900th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army,Fuzhou 350001,China;Dongfang Hospital,Xiamen University,Fuzhou 350001,China;Clinical Medical College,Fuzhou General Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇〇医院普通外科,福建福州350001 [2]厦门大学东方医院,福建福州350001 [3]福建医科大学福州总医院临床医学院,福建福州350001

出　　处：《中国普通外科杂志》2021年第12期1434-1440,共7页China Journal of General Surgery

基　　金：福建省自然科学基金资助项目(2017J01327)。

摘　　要：背景与目的:近年来,随着介入技术及器械的不断进步,血管内异物(IFB)的取出技术有了一定的进展,但由于异物的类型、留置部位、大小等的不同,IFB取出的操作难度不同。因此,本文中笔者对近年来收治的医源性与非医源性IFB患者的治疗经过进行分析总结,以期为临床诊治此类疾病提供参考。方法:回顾性分析2012年1月-2021年9月中国人民解放军联勤保障部队第九〇〇医院普通外科收治的15例IFB患者资料,对异物来源,残留部位,手术过程等进行总结,并复习相关文献。结果:15例患者中医源性IFB 12例,非医源性IFB 3例;男9例,女6例;年龄21~79岁,平均为(56.67±17.63)岁;手术时间为20~110 min,平均(51±23.62) min;原发病包括外伤性3例,乳腺癌2例,胃癌2例,下肢深静脉血栓形成2例,肺癌2例,肝癌1例,宫颈癌1例,脑梗死伴颈动脉狭窄1例,肾功能不全1例。15例IFB均顺利取出,技术成功率为100%,单纯介入治疗取出异物10例,1例行腹腔镜下异物取出术,4例行传统外科手术切开取出。术前除1例因血管支架移位导致主动脉破裂大出血外,其余患者均未出现相应并发症,如血管破裂、出血、感染、继发性血栓形成等;术后给予抗凝治疗,15例患者经随访,均未出现并发症,超声复查血管通畅。结论:大多数IFB患者可通过急诊手术处理,首选治疗方式采用介入治疗方式,对于简单病例,可通过鹅颈抓捕器进行抓捕异物,而针对较难取出的患者,可通过导丝塑形或改用较大的环形圈套器,操作者术中需耐心操作;对于介入操作困难的病例,可结合临床具体情况,术中中转腹腔镜或开放手术进行治疗,安全性也较好。Background and Aims: In recent years, a certain progress has been achieved in techniques for intravascular foreign body(IFB) retrieval with the development of interventional technologies and devices. However, IFB retrieval presents different degrees of operative difficulty due to the different types, lodgment sites and sizes of the IFB. Therefore, the authors summarized and analyzed the treatment processes of patients with iatrogenic and non-iatrogenic IFB admitted in recent years in this paper,aiming to provide some helpful guidance for clinical practice.Methods: The data of 15 patients with IFB treated in the Department of General Surgery of the 900 th Hospital of the Chinese People’s Liberation Army Joint Service Support Force from January 2012 to September 2021 were retrospectively analyzed. The sources and lodgment sites of the IFB, and surgical procedures were summarized, with review of the relevant literature.Results: Of the 15 patients, 12 cases were iatrogenic IFB and 3 cases were non-iatrogenic IFB, and 9 cases were males and 6 cases were females, aged 21-79 years, with an average of(56.67±17.63) years. The operative time was 20-110 min, with an average of(51±23.62) min. The primary diseases included3 cases of trauma, 2 cases of breast cancer, 2 cases of gastric cancer, 2 cases of deep vein thrombosis of lower limbs, 2 cases of lung cancer, 1 case of liver cancer, 1 case of cervical cancer, 1 case of cerebral infarction with carotid artery stenosis, 1 case of renal insufficiency. The IFB was successfully removed in all the 15 patients, the technical success and rate was 100%. Ten cases were removed by interventional therapy alone, 1 case was removed under laparoscopic surgery, 4 cases were removed by incision of the traditional surgery. Except for 1 case of aortic rupture and massive hemorrhage caused by vascular stent displacement before operation, the other cases had no corresponding complications, such as vascular rupture, bleeding, infection, secondary thrombosis. Anticoagulation treatment was a

关 键 词：异物 血管 血管内操作 最小侵入性外科手术 

分 类 号：K654.3[历史地理—历史学]