[1]张 骞,汪海洋,付 健,等.导管接触溶栓与切开取栓治疗急性下肢缺血效果比较[J].介入放射学杂志,2019,28(03):223-227.
 ZHANG Qian,WANG Haiyang,FU Jian,et al.Catheter- directed thrombolysis versus surgical thrombectomy for acute lower limb ischemia: comparison of clinical effect[J].journal interventional radiology,2019,28(03):223-227.
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导管接触溶栓与切开取栓治疗急性下肢缺血效果比较()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
28
期数:
2019年03期
页码:
223-227
栏目:
血管介入
出版日期:
2019-03-25

文章信息/Info

Title:
Catheter- directed thrombolysis versus surgical thrombectomy for acute lower limb ischemia: comparison of clinical effect
作者:
张 骞 汪海洋 付 健 孙建明
Author(s):
ZHANG Qian WANG Haiyang FU Jian SUN Jianming.
Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
关键词:
【关键词】 急性下肢缺血 导管接触溶栓 切开取栓
文献标志码:
A
摘要:
【摘要】 目的 比较股动脉切开取栓和导管接触溶栓(CDT)治疗急性下肢缺血(ALLI)的有效性和安全性。方法 回顾性分析2012年1月至2017年12月采用切开取栓或CDT治疗的ALLI患者临床资料。评估术后30 d内并发症发生率、死亡率、再干预率及截肢率。Cooley疗效标准评估美国血管外科协会(SVS)/国际心血管外科学会(ISCVS)急性肢体缺血分级为Ⅱ级患者临床效果。结果 共纳入患者107例,其中59例接受CDT,48例接受切开取栓治疗。两组技术成功率均为100%。CDT组、切开取栓组患者术后30 d内并发症发生率(11.9%对14.6%)、死亡率(5.1%对6.3%)、再次手术干预率(17.0%对22.9%)差异均无统计学意义(P>0.05);CDT组SVS/ISCVS缺血分级为Ⅱ级患者截肢率高于切开取栓组,但差异无统计学意义(8.9%对2.3%,P>0.05)。根据病因和Cooley 疗效标准评估缺血分级Ⅱ级患者出院时下肢缺血改善情况,动脉栓塞患者痊愈比例在切开取栓组大于CDT组(82.5%对62.8%,P<0.05),血栓形成患者痊愈比例在CDT组大于切开取栓组(92.3%对 25.0%,P<0.05);根据缺血时间和Cooley 疗效标准评估患者出院时缺血改善情况,两组差异无统计学意义(P>0.05)。结论 切开取栓、CDT两种术式治疗ALLI效果、术后并发症发生率和死亡率差异均无统计学意义。应根据患者SVS/ISCVS缺血分级、病因及伴有基础疾病制定治疗方案。

参考文献/References:

[1] Alonso- Coello P, Bellmunt S, McGorrian C, et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines[J]. Chest, 2012, 141(2 Suppl): e669S- e690S.
[2] Gilliland C, Shah J, Martin JG, et al. Acute limb ischemia[J]. Tech Vasc Interv Radiol, 2017, 20: 274- 280.
[3] Theodoridis PG, Davos CH, Dodos I, et al. Thrombolysis in acute lower limb ischemia: review of the current literature[J]. Ann Vasc Surg, 2018, 52: 255- 262.
[4] 陈跃鑫, 周梦馨, 刘昌伟. 下肢缺血性疾病规范化治疗争议与共识[J]. 中国实用外科杂志, 2017, 37: 1349- 1354.
[5] Karnabatidis D, Spiliopoulos S, Tsetis D, et al. Quality improvement guidelines for percutaneous catheter- directed intra- arterial thrombolysis and mechanical thrombectomy for acute lower- limb ischemia[J]. Cardiovasc Intervent Radiol, 2011, 34: 1123- 1136.
[6] Berridge DC, Kessel DO, Robertson I. Surgery versus thrombolysis for initial management of acute limb ischaemia[J]. Cochrane Database Syst Rev, 2013, 6: CD002784.
[7] Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene[J]. Semin Vasc Surg, 2009, 22: 5- 9.
[8] 公茂峰, 顾建平, 陈国平, 等. AngioJet血栓清除术在急性下肢动脉缺血治疗中的应用[J]. 介入放射学杂志, 2017, 26: 509- 513.
[9] Gandhi SS, Ewing JA, Cooper E, et al. Comparison of low- dose catheter- directed thrombolysis with and without pharmacome- chanical thrombectomy for acute lower extremity ischemia[J]. Ann Vasc Surg, 2018, 46: 178- 186.
[10] 张昌明, 张福先, 张 欢. 经导管溶栓治疗急性下肢缺血疗效分析[J]. 介入放射学杂志, 2012, 21: 780- 783.
[11] 李孝成, 潘光栋, 肖运平, 等. 导管溶栓治疗急性下肢缺血30例[J]. 介入放射学杂志, 2014, 23: 250- 252.
[12] Ebben HP, van Burink MV, Jongkind V, et al. Efficacy versus complications in arterial thrombolysis[J]. Ann Vasc Surg, 2018, 48: 111- 118.
[13] 褚永新, 张 雷, 李斌本, 等. AngioJet仪治疗急性下肢股腘动脉栓塞的体会[J]. 临床外科杂志, 2017, 25: 378- 381.
[14] Leung DA, Blitz LR, Nelson T, et al. Rheolytic pharmacome- chanical thrombectomy for the management of acute limb ischemia: results from the PEARL registry[J]. J Endovasc Ther, 2015, 22: 546- 557.
[15] 解志磊, 徐敦元, 王文利, 等. AngioJet机械血栓抽吸术在急性下肢缺血中的应用体会[J]. 血管与腔内血管外科杂志, 2017, 3: 892- 893.
[16] 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: 729- 736.
[17] Kwok CHR, Fleming S, Chan KKC, et al. Aspiration thrombectomy versus conventional catheter- directed thrombolysis as first- line treatment for noniatrogenic acute lower limb ischemia[J]. J Vasc Interv Radiol, 2018, 29: 607- 613.
[18] 赵 健, 刘兆玉, 马羽佳, 等. 大管径导管抽吸血栓治疗急性下肢动脉栓塞的疗效分析[J]. 医学影像学杂志, 2017, 27: 1546- 1549.
[19] Taha AG, Byrne RM, Avgerinos ED, et al. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia[J]. J Vasc Surg, 2015, 61: 147- 154.

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备注/Memo

备注/Memo:
(收稿日期:2018-07-02)
(本文编辑:边 佶)
更新日期/Last Update: 2019-03-20