AcoStream外周血栓抽吸导管吸栓术与血栓切除术治疗急性下肢动脉栓塞的疗效分析  

Analysis of the efficacy of AcoStream peripheral thrombectomy catheter thrombosis removal and DSA-guided thrombectomy in the treatment of acute lower extremity arterial embolism

作　　者：李鲁滨[1] 董恒阳 孙转友 齐子昊 杨牟[1] 刘颖[2] 张居文[1] 田雨 车海杰[1] 王程杰 Li Lubin;Dong Hengyang;Sun Zhuanyou;Qi Zihao;Yang Mu;Liu Ying;Zhang Juwen;Tian Yu;Che Haijie;Wang Chengjie(Department of Vascular Surgery,Yantai Yuhuangding Hospital,Yantai 264000,China;Second Clinical Medical College,Binzhou Medical University,Yantai 264003,China)

机构地区：[1]烟台毓璜顶医院血管外科,烟台264000 [2]滨州医学院第二临床医学院,烟台264003

出　　处：《中华血管外科杂志》2024年第3期181-187,共7页Chinese Journal of Vascular Surgery

基　　金：山东省医药卫生科技项目(202304110625)。

摘　　要：目的对比AcoStream外周血栓抽吸导管吸栓术与数字减影血管造影(DSA)指导下取栓术治疗急性下肢动脉栓塞的疗效。方法本研究为回顾性队列研究。回顾性分析2021年1月至2023年6月于烟台毓璜顶医院血管外科行DSA指导下取栓术或AcoStream外周血栓抽吸导管吸栓术治疗的103例单侧急性下肢动脉栓塞患者的临床资料。根据治疗方式不同, 分为DSA指导下取栓术组(取栓组, n=69)和AcoStream外周血栓抽吸导管吸栓术组(吸栓组, n=34)。比较两组患者手术前后血管通畅情况、手术时长、术中出血量、住院费用、住院天数及动脉损伤、远端栓塞、截肢、死亡等不良事件的发生情况。结果取栓组手术成功率为100%(69/69), 吸栓组为94.1%(32/34)。吸栓组手术时长[(148.38±50.48)min比(175.33±39.80)min, t=2.952, P=0.004]和住院时间[4.50(3.00, 6.00)d比8.00(6.00, 10.00)d, Z=5.978, P<0.001]均短于取栓组, 差异有统计学意义;而两组术中出血量及住院费用差异无统计学意义(均P>0.05)。两组患者术后卢瑟福分级[取栓组:0(0, 1.00)比2.55±0.72, Z=9.534, 吸栓组:0(0, 1.00)比2.56±0.70, Z=6.190]、踝肱指数(ABI)[取栓组:0.83±0.08比0.47±0.18, t=26.550;吸栓组:0.83±0.07比0.43±0.15, t=10.647]及跛行距离[取栓组:(527.25±197.08)m比0(0, 0)m, Z=10.637;吸栓组:(537.35±158.06)m比0(0, 0)m, Z=7.327]均优于术前, 差异均有统计学意义(均P<0.001)。但不管是术前还是术后的卢瑟福分级、ABI和跛行距离, 以及术后的心肌梗死溶栓治疗后血流分级的比较, 两组间的差异均无统计学意义(均P>0.05)。两组在动脉损伤、远端栓塞、截肢及死亡等不良事件的发生方面, 差异均无统计学意义(均P>0.05)。结论 AcoStream外周血栓抽吸导管吸栓术与DSA指导下取栓术治疗急性下肢动脉栓塞均可取得良好疗效, 且前者较后者具有减少手术时长、缩短住院时间及操作简单等优势。Objective To compare the benefits of AcoStream peripheral thrombectomy catheter thrombosis removal and digital subtraction angiography(DSA)guided embolectomy in the treatment of acute lower extremity arterial embolism.Methods This study was a retrospective cohort study.Clinical data of 103 patients with unilateral acute lower extremity arterial embolism treated with DSA-guided embolectomy(thrombectomy group,n=69)or AcoStream peripheral thrombectomy catheter thrombosis removal(aspiration group,n=34)in the Department of Vascular Surgery at Yantai Yuhuangding Hospital from January 2021 to June 2023 were collected retrospectively.The vascular patency before and after operation,operative duration,intraoperative bleeding,hospitalization costs,length of hospital stay,as well as incidence of adverse events such as arterial injury,distal embolism,amputation,and mortality were compared between the two groups.Results The surgical success rate of the thrombectomy group was 100%(69/69),while the aspiration group had a success rate of 94.1%(32/34).The operative duration[(148.38±50.48)min vs.(175.33±39.80)min,t=2.952,P=0.004]and length of hospital stay[4.50(3.00,6.00)d vs.8.00(6.00,10.00)d,Z=5.978,P<0.001]in the aspiration group were both shorter than those in the thrombectomy group,and the differences were statistically significant.And there was no statistically significant difference in intraoperative bleeding and hospitalization costs between the two groups(both P>0.05).The degree of postoperative Rutherford classification[thrombectomy group:0(0,1.00)vs.2.55±0.72,Z=9.534;aspiration group:0(0,1.00)vs.2.56±0.70,Z=6.190],ankle brachial index(ABI)(thrombectomy group:0.83±0.08 vs.0.47±0.18,t=26.550;aspiration group:0.83±0.07 vs.0.43±0.15,t=10.647)and claudication distance[thrombectomy group:(527.25±197.08)m vs.0(0,0)m,Z=10.637;aspiration group:(537.35±158.06)m vs.0(0,0)m,Z=7.327]were all better than preoperative in two groups,and the differences were statistically significant(both P<0.001).However,there was no statistic

关 键 词：急性下肢动脉栓塞 血栓切除术 AcoStream外周血栓抽吸导管吸栓术 跛行 

分 类 号：R654.4[医药卫生—外科学]