«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

23卷

期数:

2017年05期

页码:

430-433

栏目:

临床医学

出版日期:

2017-09-20

文章信息/Info

Title:

Short-term result of percutaneous mechanical thrombectomy for treating artery stenosis disease accompanied with thrombosis of lower extremity

文章编号:

1006-8147(2017)05-0430-04

作者:

李宏伟; 罗宇东; 范海伦; 冯舟; 朱杰昌; 张益伟; 胡凡果;  戴向晨

(天津医科大学总医院血管外科，天津 300052)

Author(s):

LI Hong-wei; LUO Yu-dong; FAN Hai-lun; FENG Zhou; ZHU Jie-chang; ZHANG Yi-wei; HU Fan-guo; DAI Xiang-chen

(Department of Vascular Surgery，General Hospital，Tianjin Medical University, Tianjin 300052,China)

关键词:

下肢动脉狭窄; 血栓形成; 经皮机械血栓清除术; 置管溶栓术

Keywords:

lower extremity artery stenosis disease; thrombosis; percutaneous mechanical thrombectomy; catheter directed thrombolysis

' target="_blank" rel="external">" />

分类号:

R654.4

DOI:

-

文献标志码:

A

摘要:

目的：评价经皮机械血栓清除术（PMT）治疗下肢动脉狭窄伴血栓形成病变的有效性及安全性。方法：选取初始治疗应用减容治疗方法的下肢动脉狭窄伴血栓形成患者共102例。按减容方法不同，分为经皮机械血栓清除联合置管溶栓（PMT+CDT)组（27例）及单纯置管溶栓组(CDT)组（75例）。减容治疗后视治疗结果给予经皮腔内血管成形术(PTA)+支架置入等后续处理。对比两组一般情况、术中情况（失血量、造影剂用量）、围手术期情况（尿激酶用量、介入次数、减容时间、减容相关并发症）、减容有效性、减容费用 、踝肱指数（ABI）、术后6个月再狭窄等情况。结果：两组患者术前一般情况无统计学差异（P＞0.05）；PMT+CDT组减容有效性显著高于CDT组（P＜0.05）；同组内比较，两组术后1周及6个月ABI均显著高于术前（P＜0.05）；两组间同时点比较，ABI无统计学差异（P＞0.05）；两组在术后6个月再狭窄率方面无统计学差异（P＞0.05），但在支架内再狭窄病例亚组中PMT+CDT组的6个月再狭窄率显著低于CDT组（P＜0.05）；PMT+CDT组的造影剂用量、介入次数、尿激酶用量、减容时间以及减容相关并发症发生率显著低于CDT组（P＜0.05），失血量、减容费用显著高于CDT组（P＜0.05）。结论：经皮机械血栓清除术有效、省时、安全，可作为下肢动脉狭窄伴血栓形成患者的首选初始治疗方法。

Abstract:

?Objective：To evaluate the efficacy and safety of percutaneous mechanical thrombectomy（PMT） for treating artery stenosis disease accompanied with thrombosis of lower extremity. Methods: One hundredand two patients with artery stenosis disease accompanied with thrombosis of lower extremity were enrolled in this study, who were given debulking treatment as primary treatment . The patients were divided into 2 groups,PMT combined with catheter directed thrombolysis (PMT+CDT) group(n=27) and catheter directed thrombolysis( CDT) group (n =75). After that, the patients were treated with subsequent relative methods according to the result of the debulking treatment, including percutaneous transluminalangioplasty(PTA) and stent placement. The general conditions of individuals, intraoperative conditions (including blood loss of the operation, total dose of contrast media), perioperative conditions (including total dose of urokinase, period of debulkingtreatment ,times of intervention, complications of debulking treatment) ,efficacy of debulking treatment, cost of debulking treatment, ankle-brachial index (ABI) ,rate of restenosis of six months post-operation were compared between two groups. Results: There were no statistically significant differences in general conditions between the two groups(P＞0.05). The efficacy of debulking treatment was significantly more effective in PMT+CDT group (P＜0.05. At the same time point of pre or post operation , there were no significant differences in ABI between 2 groups (P＞0.05). ABI for a week and six months post-operation were higher than ABI preoperation in the same group (P＜0.05＝. There was no statistically significant difference in the rate of restenosis of six months post-operation. The rate of restenosis of six months post-operation in subgroup of in-stent restenosis was analyzed, which revealed that the rate of PMT+ CDT group was significantly lower(P＜0.05＝. Compared with CDT group, times of intervention, total dose of contrast media, total dose of urokinase, time of debulking treatment, complications of debulking treatment were significantly decreased in PMT+ CDT group(P＜0.05),but the cost of debulking treatment and blood loss in the operation were significantly higher(P＜0.05). Conclusion: PMT+CDT,which is significantly effective, safe and time-saving , could be a preferred therapy in the primary treatment of arterial stenosis disease accompanied with thrombosis of lower extremity.

参考文献/References:

[1]李国剑，杨镛，杨国凯，等. 置管溶栓联合多种腔内介入微创技术在下肢动脉硬化闭塞症中的疗效评价[J].中国普外基础与临床杂志, 2015,22(9): 1068

[2]Lichtenberg M. Percutaneous mechanical thrombectomy by means of rotational thrombectomy. Current study situation[J]. MedizinischeKlinik, 2010,105(10):705

[3]Masaki H,Tabuchi A,Yunoki Y, et al.Collective therapy and therapeutic strategy for critical limb ischemia[J].Ann Vasc Dis,2013,6(1):27

[4]Yamada T,OnishiK,Hirata A, et al.Treatment strategy for critical limb ischemia in our hospital:approaches mainly under the leadership of the departments of cardiovascular internal medicine and plastic surgery[J].J Japan Soc Limb Salvage Podiatric Med,2012,4(4):185

[5]田硕, 黄新天, 殷敏毅, 等. 下肢动脉粥样硬化闭塞症腔内治疗后再闭塞的原因分析及应对策略[J]. 中国血管外科杂志电子版, 2013,5(2):83

[6]郑江华, 陈开, 陈志龙, 等. TASC-Ⅱ C/DC/D级髂动脉闭塞的腔内治疗. 中国普外基础与临床杂志, 2015,22(2):216

[7]李大林, 张鲲, 颜京强, 等. 股浅动脉闭塞122例治疗体会[J].中国普外基础与临床杂志,2015,22(2):230

[8]Arbid J,Elias J.Endovascular techniques in limb salvage:infrapopliteal angioplasty[J].Methodist DebakeyCardiovasc J,2013,9(2):103

[9]Johnston KW. Femoral and popliteal arteries: reanalysis of results of balloon angioplasty[J]. Radiology, 1992, 183(3):767

[10]Dattilo P B,Casserly I P.Critical limb ischemia: endovascular strategies for limb salvage[J].ProgCardiovasc Dis,2011,54(1):47

[11]栗力.下肢动脉硬化闭塞症术后再闭塞的腔内治疗[J].中国血管外科杂志:电子版,2014,6(2):68

[12]包俊敏.下肢动脉闭塞症腔内治疗后再狭窄的反思[J].中国血管外科杂志:电子版,2010,02(2):71

[13]邢越, 朱峥嵘, 谭羽灿, 等. 腔内治疗股髂动脉硬化性闭塞症58例临床分析. 中华普通外科学文献:电子版, 2016,10(1):68

[14]Laird J R,Katzen B T,Scheinert D, et al.Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: Three-Year follow-up from the RESILIENT randomized trial[J].JEndovasc Ther,2012,19(1):1

[15]Sixt S,CarpioCancino O G,Treszl A, et al.Drug-coated balloon angioplasty after directional atherectomy improves outcome in restenoticfemoropoplitealarteries[J].J Vasc Surg,2013,58(3):682

相似文献/References:

备注/Memo

备注/Memo:

作者简介 李宏伟（1987-），男，硕士在读，研究方向：血管外科；通信作者：戴向晨， E-mail ：13302165917@163.com。

常用功能

更新日期/Last Update: 2017-09-20