两种经皮机械血栓清除方式对急性下肢缺血的疗效与安全性研究  

Efficacy and safety of two percutaneous mechanical thrombectomy methods in the treatment of acute lower limb ischemia

作　　者：胡斌 赵文军[2] 陈光[2] 李栋林[3] HU Bin;ZHAO Wenjun;CHEN Guang;LI Donglin(不详;Zhejiang University School of Medicine,Hangzhou 310030,China)

机构地区：[1]浙江大学医学院,杭州310030 [2]浙江省台州医院血管外科 [3]浙江大学医学院附属第一医院血管外科

出　　处：《浙江医学》2024年第10期1067-1073,共7页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF20H020007)。

摘　　要：目的比较两种经皮机械血栓清除方式(Rotarex机械血栓切除和Angiojet机械血栓抽吸)对急性下肢缺血的临床疗效及安全性差异。方法回顾性选取2020年2月至2023年2月浙江省台州医院血管外科收治并行机械血栓清除治疗的急性下肢缺血患者98例,其中采用机械血栓切除术38例(Rotarex组),机械血栓抽吸术60例(Angiojet组)。收集两组患者基线资料,比较两组手术技术成功率等临床疗效指标、并发症情况等安全性评估指标。结果两组患者缺血原因、缺血程度、发病时间等基线资料比较差异均无统计学意义(均P>0.05)。Rotarex组患者手术技术成功率为100.00%,Angiojet组为98.33%。Rotarex组血栓清除后残存狭窄[(46.18±12.97)%比(54.25±14.67)%]、支架置入率(47.37%比73.33%)、踝肱指数改善值[(0.67±0.10)比(0.63±0.11)]、术后住院天数[5(3,6)d比7(5.5,8.5)d]均优于Angiojet组(均P<0.05)。两组患者缺血症状改善情况、30 d内截肢率、30 d内再次手术率比较差异均无统计学意义(均P>0.05)。与术前比较,Angiojet组患者术后WBC、中性粒细胞/淋巴细胞计数比值、CRP升高(均P<0.05),而Hb下降(P<0.05)。两组患者围术期肝肾功能、Fib、D-二聚体指标和并发症发生情况比较差异均无统计学意义(均P>0.05)。结论Rotarex机械血栓切除和Angiojet机械血栓抽吸这两种方式对急性下肢缺血均有良好的疗效及安全性,但Rotarex系统相对更具疗效优势,血栓清除效率更佳,且对内环境影响更小,安全性更高。Objective To compare the clinical efficacy and safety of two percutaneous mechanical thrombectomy methods(Rotarex vs.Angiojet)in the treatment of acute lower limb ischemia(ALLI).Methods Retrospective analysis was conducted on 98 patients treated with ALLI using Rotarex or Angiojet in the Department of Vascular Surgery,Taizhou Hospital,Zhejiang Province from February 2020 to February 2023.Among which,38 patients received mechanical thrombectomy(Rotarex group)and 60 patients received mechanical thrombus aspiration(Angiojet group).The baseline data of the two groups were collected,and the clinical efficacy indexes such as the success rate of surgical techniques and the safety evaluation indexes such as complications were compared between the two groups.Results There were no significant differences in baseline data including the cause and degree of ischemia and time of onset between the two groups(all P>0.05).The technical success rate was 100.00%in the Rotarex group and 98.33%in the Angiojet group.In the Rotarex group,residual stenosis[(46.18±12.97)%vs.(54.25±14.67)%],stent implantation rate(47.37%vs.73.33%),ankle-brachial index(ABI)improvement value[(0.67±0.10)vs.(0.63±0.11)],and postoperative hospital stay[5(3,6)d vs.7(5.5,8.5)d]were better than those of the Angiojet group(all P<0.05).There were no significant differences in improvement of ischemic symptoms,and amputation and reoperation rate within 30 days between the two groups(all P>0.05).Compared with preoperative results,postoperative WBC,neutrophil/lymphocyte count ratio and CRP in Angiojet group were increased(all P<0.05),while Hb was decreased(P<0.05).The two groups showed no significant differences in perioperative liver and kidney functions,Fib,D-dimer and incidence of complications(all P>0.05).Conclusion Both Rotarex and Angiojet techniques have good efficacy and safety for acute lower limb ischemia,but Rotarex system is more superior in efficacy,and thrombectomy efficiency with less impacts on the internal environment and higher safety.

关 键 词：机械血栓清除 动脉栓塞 急性血栓形成 临床疗效 安全性 

分 类 号：R654.4[医药卫生—外科学]