血管缝合器在股动脉穿刺病例中的应用研究

Application of vascular closure devices in cases of femoral artery puncture

目的探索Perclose缝合器在股动脉穿刺止血的价值及其对血管及远端血供的影响。方法收集广西医科大学第一附属医院2012年12月-2013年7月行肝动脉介入(TACE)患者135例,按照非完全随机对照原则分成实验组(69例)和对照组(66例),比较两组术前、术后2 d及术后1个月的穿刺部位股动脉周径、血流速度、踝-肱指数(ABI)、两组手术成功率、术后舒适度及术后并发症等的差异。结果试验组手术成功率为98.6%,对照组为100.0%,两组差异无统计学意义(P=0.671);两组术前、术后1个月ABI、血流速度、穿刺点股动脉内径组间差异无统计学意义(P>0.050);试验组术后2 d血流速度、穿刺点股动脉内径均小于对照组(P=0.006和0.030),试验组术后2 d ABI组间差异无统计学意义(P=0.500);实验组在舒适度方面明显优于对照组(P=0.001);两组的手术并发症差异无统计学意义(P=0.158)。结论肝动脉介入术后使用血管缝合器在近期安全有效,对股动脉及远端血供无明显影响,并能有效减少患者术后不适感,但远期疗效仍需进一步观察。

Objective To discuss the value of the Perclose technique for the puncture and closure of femoral access sites and vascular blood supply.Methods Totally 135 patients who received transcatheter arterial chemoembolization（TACE）in the First Affiliated Hospital of Guangxi Medical University from December 2012 to July 2013 were screened and randomly divided into study group（69 cases）and control group（66 cases）.Femoral artery diameter,blood flow velocity,ankle brachial index（ABI）,comfort degree and complications were compared before operation and 2 days and 1 month after operation.Results No significant differences in baseline characteristics existed between the two groups.The technical success rate was 98.6%in the study group and 100.0% in the control group.There was no significant difference in ABI,femoral artery diameter or blood flow velocity between both groups before operation and 1 month after operation（P〉 0.05）.Femoral artery diameter was smaller and blood flow velocity was slower in the study group than in the control group 2 days after operation with significant differences（P = 0.006 and 0.030）.After 1-month followup,no significant differences in complications were found（P = 0.158）.Conclusions The Perclose Pro Glide technique is easy to use,safe,and effective for TACE.More experience with longer follow-up is needed to assess its potential.