Rotarex机械血栓切除系统治疗急性下肢缺血的近期结果分析  

Analysis of short-term results of Rotarex mechanical thrombectomy system in the treatment of acute limb ischemia

作　　者：卓华威 陈小宇 张卫刚 陶银煜 秦怡 李铄 李承龙[2] 毛由军 ZHUO Huawei;CHEN Xiaoyu;ZHANG Weigang;TAO Yinyu;QIN Yi;LI Shuo;LI Chenglong;MAO Youjun(Department of Vascular Surgery,The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China;Department of Vascular Surgery,the Second Affiliated Hospital,Soochow Univesity,Suzhou,Jiangsu 215004,China)

机构地区：[1]南京医科大学附属常州第二人民医院血管外科,江苏常州213000 [2]苏州大学附属第二医院血管外科,江苏苏州215004

出　　处：《手术电子杂志》2022年第3期14-19,共6页Electronic Journal of Medical Operations

基　　金：常州市卫健委青年人才科技项目(QN202031);苏州市第五批姑苏卫生人才.青年拔尖人才项目(GSWS2019038)论著。

摘　　要：目的分析Rotarex机械血栓切除系统治疗急性下肢缺血(acute limb ischemia,ALI)的有效性、安全性及近期随访结果。方法以2021年4月-2022年2月期间我科运用Rotarex系统治疗ALI的11例患者(11条肢体)为研究对象,统计分析其临床特征资料、术中情况、手术效果以及随访情况等资料。结果手术时间40~170 min,平均(92.73±37.71)min;11例患者均实现技术成功,其中1例因血栓累及膝下动脉远端行尿激酶溶栓处理,1例机械血栓清除(percutaneous mechanical thrombectomy,PMT)效果欠佳行辅助性导管接触性溶栓(catheter-directed thrombolysis,CDT)治疗;所有病例术中均行球囊扩张成形;5例因残留狭窄植入支架,1例因血管挫伤植入支架;10例实现临床成功,1例术后出现足趾坏死;1例发生腓动脉近端穿孔的技术相关不良事件;未发生主要不良事件。随访时间1~11个月,中位时间6个月;1例患者术后出现足趾坏死,其余患者随访靶血管通畅,无再次血运重建事件发生,无死亡、足趾肢体坏死或致残性心脑血管意外事件等发生。结论Rotarex机械血栓切除系统治疗ALI的有效性、安全性及近期随访结果良好,其中远期效果有待于大型、多中心随机临床试验进一步验证。Objective To analyze the efficacy,safety and short-term results of Rotarex mechanical thrombectomy system in the treatment of acute limb ischemia(ALI).Methods Eleven patients(11 limbs)with ALI treated by Rotarex system in our department from April 2021 to February 2022 were studied.The clinical characteristics,intraoperative conditions,surgical effects and follow-up were analyzed.Results The operation time was 40-170 min,with an average of(92.73±37.71)min.All 11 patients achieved technical success,and 1 patient was treated with thrombolysis by urokinase due to the distal artery thrombus and 1 patient was treated with adjuvant catheter-directed thrombolysis(CDT)due to poor effect of percutaneous mechanical thrombectomy(PMT).Balloon dilatation was performed during all of the operation.Stents were implanted in 5 patients due to stenosis,and in 1 patient due to vascular contusion.Ten patients achieved clinical success,and 1 patient had toe necrosis after operation.One patient had a technology related adverse event,which was peroneal artery perforation in PMT.No major adverse events occurred.The follow-up time were 1-11 months,and the median time was 6 months.One patient had toe necrosis after operation.The other target vessels'patency was 100%,no clinically driven target lesion revascularization events occurred,and no death,necrosis or disabling cardiovascular and cerebrovascular accidents occurred.Conclusion Rotarex mechanical thrombectomy system is effective,safe and has good short-term follow-up results in the treatment of ALI.The medium and long-term effects need further verification by large and multicenter randomized clinical trials.

关 键 词：急性下肢缺血 Rotarex 有效性 安全性 随访结果 

分 类 号：R654.4[医药卫生—外科学]