大腔导管吸栓术联合置管溶栓术治疗急性下肢动脉栓塞的疗效观察

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摘要目的：探讨大腔导管吸栓术联合置管溶栓术治疗急性下肢动脉栓塞（Acute limb arterial embolism，AE）的临床效果。方法：回顾分析我院收治的32例AE患者。所有患者均进行急诊经皮穿刺下肢动脉造影，明确栓塞部位和范围后，行大腔导管吸栓术并反复数次，术后造影评估血流通畅程度，术毕留置导管溶栓。结果：32例患者经大腔导管吸栓术后，均顺利开通栓塞动脉，有14例患者吸栓后因细小栓子脱落引起远端血管栓塞，经尿激酶溶栓治疗后，9例完全开通，3例部分开通，2例未能开通，但侧支循环较前明显增多。随访（20±5）月，27例患者下肢缺血症状完全消失，4例栓塞侧足部皮肤苍白、皮温低、末梢血运差，1例行截肢治疗。结论：大腔导管吸栓术联合置管溶栓术治疗AE，能够快速清除血栓、恢复血流，临床效果好。

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	纪昌学
	鞠帅
	张飚

关键词 ：栓塞, 胆固醇, 下肢, 血管造影术

Abstract：Objective: To investigate the clinical effect of percutaneous catheter aspiration embolectomy with catheter-directed thrombolysis in the treatment of acute limb arterial embolism(AE). Methods: The clinical data of 32 patients with AE were retrospectively analyzed in our hospital． Emergency angiography of lower extremity was performed in all patients. After definite location and scope of embolization, percutaneous catheter aspiration embolectomy was performed and repeated several times. The blood flow patency degree was evaluated by angiography, and catheter thrombolysis was performed at the end of the operation． Results: In all 32 cases after catheter aspiration embolectomy, the arteries were successfully reopened． In 14 cases whose distal vessels were embolized by small emboli, after thrombolytic therapy with urokinase, the arteries were completely opened in 9 cases, and partially opened in 3 cases, still failed to open in 2 cases, but the collateral circulation increased significantly． Follow up (20±5) months, lower extremity ischemia symptoms completely disappeared in 27 cases, low skin temperature, pale skin, poor blood circulation in 4 cases, and 1 case had to receive amputation． Conclusion: Percutaneous catheter aspiration embolectomy combined with catheter-directed thrombolysis in the treatment of AE can promptly remove thrombus, instantly restore the blood flow, and its clinical effect is satisfied．

Key words： Embolism, cholesterol Lower extremity Angiography

收稿日期: 2017-06-26

PACS:	Ｒ543.5
	Ｒ814.43
	Ｒ815

通讯作者: 纪昌学，复旦大学附属金山医院，201508。E-mail：jchxue@126.com

作者简介: 纪昌学（1972-），男，湖北十堰人，副主任医师。E-mail：jchxue@126.com

引用本文:

纪昌学，鞠帅，张飚. 大腔导管吸栓术联合置管溶栓术治疗急性下肢动脉栓塞的疗效观察[J]. 中国临床医学影像杂志, 2018, 29(4): 284-286.
JI Chang-xue, JU Shuai, ZHANG Biao. Clinical effect of percutaneous catheter aspiration embolectomy combined with catheter-directed thrombolysis in the treatment of acute limb arterial embolism. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(4): 284-286.

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http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I4/284

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