Fogarty导管取栓术联合置管药物溶栓在足踝部游离皮瓣术后动脉栓塞中的临床应用  

Clinical Application of Fogarty Catheter Thrombectomy Combined with Catheter-Based Drug Thrombolysis in Arterial Embolization after Free Flap Surgery in the Foot and Ankle

作　　者：李小东[1] 刘飞 严晓薇[1] 姜海军[1] 王培[1] LI Xiaodong;LIU Fei;YAN Xiaowei(The Affiliated Hospital of Chengde Medical University,Hebei Chengde 067000,China)

机构地区：[1]承德医学院附属医院手足外科,河北承德067000

出　　处：《河北医学》2022年第10期1743-1748,共6页Hebei Medicine

基　　金：2016年度河北省卫生厅指令性课题,(编号:20160010);2018年承德市科学技术研究与发展计划项目,(编号:201801A037)。

摘　　要：目的:探讨Fogarty导管取栓术结合置管药物溶栓处理足踝部游离皮瓣术后动脉栓塞的疗效。方法:回顾分析2016年4月至2021年2月收治且符合选择标准的16例足踝部软组织缺损行游离皮瓣修复术,术后皮瓣出现动脉栓塞的患者临床资料。患者均采用Fogarty导管取栓术结合置管药物溶栓处理,记录手术时间、术中失血量、动脉通畅率及相关并发症发生情况。随访期间观察皮瓣六项指标联合美国矫形足踝协会(AOFAS)踝-后足功能评分予以疗效评价。结果:术后12例皮瓣完全成活,2例皮瓣部分坏死,2例再次出现动脉危象,改行切开探查术式。排除改行切开探查术的2例患者,采用该术式处理的14例患者,无大出血及死亡病例,取出的血栓长度为0.2~1.8cm,平均长度(0.83±0.32)cm,术中动脉通畅率为100%,手术时间55~90min,平均时间(65.12±12.72)min。术中失血量为35~70mL,平均失血量(55.48±9.45)mL。术后1例(7.14%)出现消化道出血,予以对症治疗。患者均获随访,随访时间8~21个月,中位随访时间14.5(10.4,16.5)个月,2例(14.3%)影响穿鞋,予以皮瓣修薄后改善,1例(7.14%)出现局部溃疡,换药后愈合。末次随访时皮瓣质地良好,感觉恢复S 2~S 3级,均恢复保护性感觉,两点辨别觉均仅有1个点,皮瓣疗效满意率85.71%。足踝部功能改善,AOFAS踝-后足功能评分为59~95分,平均(83.72±6.42)分,AOFAS踝-后足功能优良率71.42%。结论:Fogarty导管取栓术联合药物溶栓处理足踝部游离皮瓣术后动脉栓塞,微创、快捷、安全,临床疗效确切。Objective:To investigate the efficacy of Fogarty catheter thrombectomy combined with catheter-based drug thrombolysis in the treatment of arterial embolism after free skin flaps in the foot and ankle.Methods:A retrospective analysis was conducted of the clinical data of 16 patients admitted from April 2016 to February 2021 with soft tissue defects in the foot and ankle who underwent free flaps and who had arterial embolism in the flaps after surgery.All patients were treated with Fogarty catheter thrombectomy combined with catheter drug thrombolysis,and the operation time,intraoperative blood loss,arterial patency rate and related complications were recorded.During the follow-up period,the six indexes of the flap combined with the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot function score were used to evaluate the curative effect.Results:After surgery,12 flaps were completely viable,2 flaps were partially necrotic,and 2 cases had a recurrence of arterial crisis and were converted to an incisional exploration approach.Excluding 2 patients who were converted to incisional exploration,the 14 patients treated with this procedure had no major bleeding or deaths.The length of the thrombus removed was 0.2~1.8 cm,with an average length of(0.83±0.32)cm.The intraoperative arterial patency rate was 100%and the operative time ranged from 55 to 90 min,with a mean time of(65.12±12.72)min.One case(7.14%)had postoperative gastrointestinal bleeding,which was treated symptomatically.All patients were followed up for 8~21 months,with a median follow-up time of 14.5(10.4,16.5)months.2 cases(14.3%)were affected by shoe wear,which improved after flap thinning,and 1 case(7.14%)developed a local ulcer,which healed after dressing change.At the last follow-up,the flap had a good texture and sensation was restored to S 2 to S 3 level,with protective sensation restored in all cases and only one point of discrimination in both cases.Foot and ankle function improved with an AOFAS ankle-hindfoot function score of 59 to 9

关 键 词：FOGARTY导管 取栓术 溶栓 游离皮瓣 动脉栓塞 

分 类 号：R658.3[医药卫生—外科学]