摘要
目的 探讨急性下肢缺血手术与介入联合的治疗方法。方法 分析2001年1月至2006年1月收治的72例（76条肢体）急性下肢缺血患者在DSA监测下行下肢动脉重建的临床资料。72例患者手术方式包括：（1）Fogarty导管取栓术45例；（2）Fogarty导管取栓＋股总动脉分叉处内膜剥脱＋补片成形5例；（3）Fogarty导管取栓＋球囊扩张支架植入2例；（4）Fogarty导管取栓术＋球囊扩张4例；（5）Fogarty导管取栓＋人工血管架桥术6例，其中股-股转流3例、腋-双股转流1例、股-胭转流1例、腹主动脉-双股动脉转流1例。（6）Fogarty导管取栓＋截肢（二期）6例；（7）Fogarty导管取栓＋腹主动脉夹层开窗术。结果 72例中，56例（59条肢体）救肢成功；7例（7条肢体）术前趾端坏死截除后愈合；6例（6条肢体）截肢；3例（4条肢体）围手术期发生多脏器功能衰竭死亡。结论 DSA监测下手术与介入联合治疗急性下肢缺血有助于提高重建下肢动脉供血成功率。手术的效果取决于肢体缺血的时间和程度以及对并发症的有效处理。
Objective To evaluate comprehensive salvage therapy for acute lower extremity ischemia（ALEI） by surgery combined with intervention. Methods Clinical data of 72 ALEI patients （76 limbs） receiving DSA comprehensive therapy under monitoring were retrospectively analyzed： Fogarty catheter embolectomy was performed in 45 cases; Fogarty catheter embolectomy ＋ endarterectomy at common femoral artery crotch ＋ graft patch repair in 5 cases; Fogarty catheter embolectomy ＋ balloon dilatation ＋ stent placement in 2 cases ; Fogarty catheter embolectomy ＋ balloon dilatation in 4 cases ; Fogarty catheter embolectomy ＋ graft bypass in 6 cases including femorofemoral bypass in 3 cases, axillobifemoral bypass in one case, femoropopliteal bypass in one case, and abdominal aortic-bifemoral bypass in one case; Fogarty catheter embolectomy ＋ amputation（ two stage） in 6 cases; Fogarty catheter embolectomy ＋ fenestration of abdominal aortic dissection in one case. Results 59 limbs （56 patients） were salvaged; 7 limbs （7 cases） healed after amputating necrotic toes; 6 limbs （6 cases） were amputated; 3 cases died of multiple organ disfunction syndrome （MODS）. Conclusions Combination surgery and interventional therapy under DSA monitoring achieves a high success rate in treating ALEI patients. Final outcome depends on the length and severity of ischemia, and proper management of complications.
出处
《中华普通外科杂志》
CSCD
北大核心
2007年第4期288-290,共3页
Chinese Journal of General Surgery
关键词
动脉闭塞性疾病
血管外科手术
下肢
介入治疗
Atrerial occlusive diseases
Vascular surgical procedures
Lower extremity
Interventional treatment
