摘要
目的 探讨急性下肢缺血的救治方法。方法 回顾性总结4年来我科收治的96例（106条肢体）急性下肢缺血患者的临床资料。106条患肢均采用外科手术治疗；主要用Fogarty管在手术室或介入室DSA监测下行取栓，8例（12条肢体）患者在取栓的基础上进行解剖外人工血管转流。结果 术中髂、股、胭、胫动脉取栓成功70例（75条肢体），11例（12条肢体）胭动脉以远取栓不成功；8例（12条肢体）股动脉近心端受阻，远心端通畅者4例行腋一双股转流，4例行股-股人工血管转流。1例（1条肢体）因胸腹主动脉夹层造成下肢缺血行腹主动脉夹层开窗术。6例（6条肢体）行近端取栓加远端Ⅰ期截肢。最终本组76例（85条肢体）救肢成功，成功率79．2％（76／96）；11例（11条肢体）截肢，截肢率11．4％（11／96）；9例（10条肢体）死亡，死亡率9．4％（9／96）。对76例（85条肢体）成功保肢者随访1～38个月，7例（7条肢体）因再栓塞或血栓形成再手术治愈。结论 取栓术是急性下肢缺血的有效治疗方法，DSA下监测取栓有助于提高疗效。手术的效果取决于肢体缺血的时间和程度以及并发症的处理。
Objective To study methods of salvage therapy for acute lower extremity （ALEI） ischemia. Methods A restrospectively analyzsis was made on the clinical data of 96 patients with consecutive 106 ALEI limbs. In which Fogarty catheter emholectomy was used as the initial treatment for ALEI in a regular operating room or in an intervention therapy room under DSA monitoring, and graft bypass after emholectomy was performed on 8 cases （ 12 limbs ）. Results In 70 cases （75 limbs ） successful embolectomy of the iliac, femoral, popliteal and tibial artery was achieved. In 11 cases （ 12 limbs ） embolectomy at distal to the popliteal artery was unsuccessful. Eight cases （ 12 limbs ） with obstruction proximal to the femoral artery were treated by axillofemoral bypass in 4 cases , and femorofemoral bypass in 4 cases. One case of thoracoabdominal aortic dissection aneurysm and lower extremity ischemia had fenestration of the abdominal aoric dissection. Proximal embolectomy and distal amputation was performed in 6 cases. Fimally, 76 （79. 2% ） cases had salvaged limbs,11 （11. 4% ） patients had amputated limbs, and 9（9. 4% ） patients died. Seventy-six patients （85 limbs ） were followed up for 1 to 38 months, 7 cases （7 limbs ） were reoperated on because of recurrent embolism. Conclusions Embolectomy is the effective treatment method for ALEI. Embolectomy under DSA monitoring can improve therapeutic results. The prognosis lies on the duration and extent of ischemia, and management of complications.
出处
《中国普通外科杂志》
CAS
CSCD
2006年第5期321-323,共3页
China Journal of General Surgery
