杂交手术在急性下肢动脉缺血救治中的应用
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摘要
目的:探讨杂交手术治疗下肢急性缺血(ALI)的临床疗效。方法:回顾性分析2011年3月—2014年4月行开放手术联合腔内技术治疗的43例患者46条ALI肢体临床资料。结果:手术技术成功率为97.7%(42/43),血栓残留率为7.0%(3/43),术后平均踝肱指数为0.85±0.48。9例(20.9%)因骨筋膜室综合征进行了切开减压术,围手术期截肢3例(7.0%),截趾1例(2.3%),死亡3例(7.0%)。1例术后3个月因脑卒中死亡,35例完成了至少12个月的随访,期间2例股腘动脉支架植入患者出现了再狭窄。结论:杂交手术治疗ALI技术成功率高,血栓残留率低,可以一期取出血栓和治疗血管病变,具有临床应用价值。
Objective:To investigate the clinical efficacy of hybrid procedures in treatment of acute limb ischemia(ALI).Methods:The clinical data of 43 patients with 46 ALI limbs undergoing combination treatment of conventional surgery and endovascular techniques between March 2011 and April 2014 were retrospectively analyzed.Results:The technical success rate was 97.7%(42/43),residual thrombosis rate was 7.0%(3/43),and the average ankle-brachial index after operation was 0.85±0.48.Nine patients(20.9%) developed osteofascial compartment syndrome and underwent open decompression,and during perioperative period,3 patients(7.0%) underwent extremity amputation,one patient(2.3%) had toe amputation,and 3 patients(7.0%) died.One patient died of cerebral infarction 3 months after operation,and 35 patients were followed-up for more than 12 months,during which time,restenosis occurred in 2 cases who had popliteal artery stent placement.Conclusion:In the treatment of ALI,hybrid surgery shows high technical success rate and low residual thrombosis rate,thrombus removal and vascular reconstruction can be simultaneously conducted,and is worthy of clinical application.
Objective:To investigate the clinical efficacy of hybrid procedures in treatment of acute limb ischemia(ALI).Methods:The clinical data of 43 patients with 46 ALI limbs undergoing combination treatment of conventional surgery and endovascular techniques between March 2011 and April 2014 were retrospectively analyzed.Results:The technical success rate was 97.7%(42/43),residual thrombosis rate was 7.0%(3/43),and the average ankle-brachial index after operation was 0.85±0.48.Nine patients(20.9%) developed osteofascial compartment syndrome and underwent open decompression,and during perioperative period,3 patients(7.0%) underwent extremity amputation,one patient(2.3%) had toe amputation,and 3 patients(7.0%) died.One patient died of cerebral infarction 3 months after operation,and 35 patients were followed-up for more than 12 months,during which time,restenosis occurred in 2 cases who had popliteal artery stent placement.Conclusion:In the treatment of ALI,hybrid surgery shows high technical success rate and low residual thrombosis rate,thrombus removal and vascular reconstruction can be simultaneously conducted,and is worthy of clinical application.
引文
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[17]Krueger K,Deissler P,Coburger S,et al.How thrombus model impacts the in vitro study of interventional thrombectomy procedures[J].Invest Radiol,2004,39(10):641-648.
[18]万恒,林智琪,刘灏,等.杂交技术在治疗TASC D型周围动脉闭塞性疾病中的应用[J].中国普通外科杂志,2014,23(6):737-741.
[19]Argyriou C,Georgakarakos E,Georgiadis GS,et al.Hybrid revascularization procedures in acute limb ischemia[J].Ann Vasc Surg,2014,28(6):1456-1462.
[20]张志轩,李晓强,段鹏飞,等.手术联合介入治疗急性下肢缺血42例[J].中华普通外科杂志,2012,27(1):25-27.
[21]厉建林,吴斐,丁语,等.急性下肢动脉缺血的杂交手术治疗[J].中华普通外科杂志,2014,29(3):207-210.
[2]Tawes R L Jr,Harris E J,Brown W H,et al.Arterial thromboembolism.A 20-year perspective[J].Arch Surg,1985,120(5):595-599.
[3]Hynes BG,Margey RJ,Ruggiero N 2nd,et al.Endovascular management of acute limb ischemia[J].Ann Vasc Surg,2012,26(1):110-124.
[4]Creager MA,Kaufman JA,Conte MS.Clinical practice.Acute limb ischemia[J].N Engl J Med,2012,366(23):2198-2206.
[5]Fogarty T.Historical reflections on the management of acute limb ischemia[J].Semin Vasc Surg,2009,22(1):3-4.
[6]de Donato G,Setacci F,Sirignano P,et al.The combination of surgical embolectomy and endovascular techniques may improve outcomes of patients with acute lower limb ischemia[J].J Vasc Surg,2014,59(3):729-736.
[7]Aune S,Trippestad A.Operative mortality and long-term survival of patients operated on for acute lower limb ischaemia[J].Eur J Vasc Endovasc Surg,1998,15(2):143-146.
[8]Braithwaite BD,Davies B,Birch PA,et al.Management of acute leg ischaemia in the elderly[J].Br J Surg,1998,85(2):217-220.
[9]Nypaver TJ,Whyte BR,Endean ED,et al.Nontraumatic lowerextremity acute arterial ischemia[J].Am J Surg,1998,176(2):147-152.
[10]Pemberton M,Varty K,Nydahl S,et al.The surgical management of acute limb ischaemia due to native vessel occlusion[J].Eur J Vasc Endovasc Surg,1999,17(1):72-76.
[11]厉建林.杂交手术治疗下肢急性动脉栓塞的策略[J].中国普通外科杂志,2013,22(6):762-765.
[12]Costantini V,Lenti M.Treatment of acute occlusion of peripheral arteries[J].Thromb Res,2002,106(6):V285-294.
[13]Palfreyman SJ,Booth A,Michaels JA.A systematic review of intraarterial thrombolytic therapy for lower-limb ischaemia[J].Eur J Vasc Endovasc Surg,2000,19(2):143-157.
[14]Wagner H J,Müller-Hülsbeck S,Pitton M B,et al.Rapid thrombectomy with a hydrodynamic catheter:results from a prospective,multicenter trial[J].Radiology,1997,205(3):675-681.
[15]Ansel GM,George BS,Botti CF,et al.Rheolytic thrombectomy in the management of limb ischemia:30-day results from a multicenter registry[J].J Endovasc Ther,2002,9(4):395-402.
[16]St?hr P,Rupprecht HJ,Voigtl?nder T,et al.A new thrombectomy catheter device(Angio Jet)for the disruption of thrombi:An in vitro study[J].Catheter Cardiovasc Interv,1999,47(3):381-389.
[17]Krueger K,Deissler P,Coburger S,et al.How thrombus model impacts the in vitro study of interventional thrombectomy procedures[J].Invest Radiol,2004,39(10):641-648.
[18]万恒,林智琪,刘灏,等.杂交技术在治疗TASC D型周围动脉闭塞性疾病中的应用[J].中国普通外科杂志,2014,23(6):737-741.
[19]Argyriou C,Georgakarakos E,Georgiadis GS,et al.Hybrid revascularization procedures in acute limb ischemia[J].Ann Vasc Surg,2014,28(6):1456-1462.
[20]张志轩,李晓强,段鹏飞,等.手术联合介入治疗急性下肢缺血42例[J].中华普通外科杂志,2012,27(1):25-27.
[21]厉建林,吴斐,丁语,等.急性下肢动脉缺血的杂交手术治疗[J].中华普通外科杂志,2014,29(3):207-210.