专题研究(Monographic Study)

导管溶栓技术在股腘动脉闭塞治疗中的应用

Published at: 2016年第25卷第12期

焦洋 1 , 李伟 1 , 张学民 1 , 李清乐 1 , 蒋京军 1 , 张韬 1 , 何长顺 1 , 贺致宾 1 , 张小明 1
1 北京大学人民医院 血管外科,北京 100044
通讯作者 洋 焦 Email: JYLP.jiao@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.12.008
基金:
北京大学人民医院研发基金资助项目 RDY2016-33

摘要

目的:探讨导管溶栓(CDT)技术治疗股腘动脉血栓性长段闭塞病变的有效性和安全性。方法:回顾性分析2012―2016年采用CDT技术治疗的71例股腘动脉长段闭塞患者临床资料。结果:全组71例均成功行CDT治疗,靶病变长度7~42 cm,平均28.2 cm,持续溶栓时间6~168 h,平均70.6 h。溶栓后血栓完全消失74.6%(53/71),血栓部分消失14.1%(10/71),溶栓无效11.3%(8/71)。全组无严重出血并发症,“垃圾足”发生率为22.5%(16/71),血管入路并发症发生率为8.6%(6/71)。1例术后死于急性心肌梗死,截肢1例。溶栓治疗中有穿刺点出血并发症的患者较无出血并发症的患者血浆纤维蛋白原浓度及血红蛋白浓度下降更明显(均P<0.05)。结论:CDT技术能有效清除血栓,是治疗股腘动脉血栓性长段闭塞病变的安全、有效手段。


Application of catheter directed thrombolysis technique in treatment of femoropopliteal occlusion

Abstract

Objective: To evaluate the effectiveness and safety of using catheter directed thrombolysis (CDT) technique in treatment of femoropopliteal long segment thrombotic occlusion. Methods: The clinical data of 71 patients with femoropopliteal long segment thrombotic occlusion undergoing CDT procedure from 2012 to 2016 were retrospectively analyzed. Results: CDT procedures were successfully performed in the whole group of 71 patients. The length of the target lesions ranged from 7 to 42 cm, with an average length of 28.2 cm, and the duration of continuous thrombolysis ranged from 6 to 168 h, with an average duration of 70.6 h. After CDT, complete thrombus removal was 74.6% (53/71), partial thrombus removal was 14.1% (10/71) and thrombolysis failure was 11.3% (8/71). No major bleeding occurred in the entire group of patients, the incidence of “trash foot” was 22.5% (16/71), and the incidence of arterial approach-related complications was 8.6% (6/71). One patient died of acute myocardial infarction after CDT procedure and one patient underwent a foot amputation. The plasma fibrinogen and the hemoglobin levels decreased more evidently in patients complicated with bleeding at the puncture site compared with those without bleeding at the puncture site (both P<0.05). Conclusion: CDT technique can effectively remove the thrombus, and is a safe and effective treatment method for femoropopliteal long segment thrombotic occlusion.


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引用

引用本文: 洋 焦, 伟 李, 学民 张, 清乐 李, 京军 蒋, 韬 张, 长顺 何, 致宾 贺, 小明 张. 导管溶栓技术在股腘动脉闭塞治疗中的应用 [J]. 中国普通外科杂志, 2016, 25(12): 1713-1718.
Cite this article as: JIAO Yang, LI Wei, ZHANG Xuemin, LI Qingle, JIANG Jingjun, ZHANG Tao, HE Changshun, HE Zhibin, ZHANG Xiaoming . Application of catheter directed thrombolysis technique in treatment of femoropopliteal occlusion [J]. Chin J Gen Surg, 2016, 25(12): 1713-1718.