下肢慢性缺血合并急性血栓形成的外科治疗

Surgical treatment for chronic lower limb ischemia complicated with acute arterial thrombosis

目的探讨治疗下肢慢性缺血合并急性血栓形成的最佳外科治疗手段。方法回顾性分析2000年1月～2010年10月我科收治的26例下肢慢性缺血合并急性血栓形成患者的临床资料,比较单纯采用股动脉切开导管取栓术组(10例)与股-腘动脉切开取栓联合动脉重建手术组(16例)的疗效。结果随访时间1～114个月,单纯股动脉切开术组中的截肢率为70%(7/10),3例1年内需行血管旁路手术;股腘动脉切开取栓联合重建手术组的手术均获成功,13例(81.3%)患者症状好转,3例因旁路血管闭塞出现不同程度的下肢缺血表现,其中2例保守治疗后症状消失,仅1例术后需再次行血管旁路手术,无截肢病例。结论股腘动脉切开取栓联合动脉重建手术的疗效优于单纯股动脉切开导管取栓术,但要重视股深动脉在恢复下肢血供中的作用,必要时加行股深动脉成形术。

Objective To explore the optimal treatment for chronic lower limb ischemia complicated with acute arterial thrombosis.Methods From Jan.2000 to Oct.2010,the clinical data of 26 patients with chronic lower limb ischemia complicated with acute arterial thrombosis were retrospectively analyzed.Then the efficacy was compared between simple femoral artery embolectomy with Fogarty catheter(10 patients) and femoropoplilteal embolectomy combined with artery reconstruction(16 patients).Results During the followed-up period(from 1 to 114 months),in simple femoral artery embolectomy group,the amputation rate was 70%(7/10),and vascular bypass was performed on 3 cases within the first year postoperatively.In femoropoplilteal embolectomy combined with artery reconstruction group,the technical success rate was 100%,the symptoms of chronic lower limb ischemia improved in 13 patients(81.3%),and hind limb ischemia because of bypass occlusion occurred in the other 3 cases,in whom 2 recovered after conservative therapy and one patient needed a second-bypass.Conclusion Femoropoplilteal embolectomy combined with suitable artery reconstruction is more effective than simple femoral artery embolectomy with Fogarty catheter.The value of the profunda artery when the superficial femoral artery occluded should be emphasized and profundaplasty is an effective alternative to distal bypass in selected patients with chronic lower limb ischemia.