急性肢体动脉栓塞87例的诊断及治疗

Clinical research of diagnosis and therapy of acute extremity arterial embolism

目的探讨急性肢体动脉栓塞的诊断和Fogarty导管取栓术的方法和疗效。方法回顾性分析了87例(89条患肢)诊断为急性肢体动脉栓塞行Fogarty导管取栓治疗患者的临床资料。结果89条患肢均根据病史、临床症状、体征和多普勒超声确诊,术前均未行肢体造影检查。所有病例均经手术证实。全组治愈78条(87.6%),患肢血供保持良好;好转4条(4.5%),未缺血坏死或截肢;截肢5条(5.6%);2例患者(2.3%)死亡。发病后48h内入院的66例(68条患肢)均治愈(治愈率100%);48h以后入院21例(21条患肢)中,10例(47.6%)治愈,4例(19.0%)好转,5例(23.8%)患肢坏死、截肢,2例(9.6%)患者死亡。结论为防止误诊,对疑有肢体动脉栓塞者应施行超声多普勒检查;Fogarty导管取栓术是治疗急性肢体动脉栓塞的有效方法;一经确诊急性肢体动脉栓塞,应尽早手术取栓,以减少肢体坏死的危险。

Objective To explore the diagnosis and Fogarty catheter embolectomy operation management of acute arterial embolism in the extremities. Methods The clinical data of 87 cases of acute arterial embolism in the extremities treated by Fogarty catheter was analyzed retrospectively. Results All cases were diagnosed through asking patient history and symptom, physical examination and the check of color Doppler while the results were proved by operadon. No one case received vasography. After operation, 78 cases blood stream of limb had been resumed and cure rate of 87. 6 % was achieved while 4 cases improved （4. 5%）, and no occurrence of ischemic necrosis and amputated extremity. 5 cases （5. 6%） received amputation at the relative level and there were 2 cases（2. 3%） of periopemtive death. Those cases who received operations within 48 hours from the time of morbidity achieved cure rate of 100%, while those cases more than 48 hours achieved cure rate of 47. 6%, improvement rate of 19. 0%, amputation rate of 23. 8% and mortality of 9. 6%. Conclusion First, Ultrasound Doppler examination should be taken for avoidance of misdiagnosis when acute extremity arterial embolism is suspected. Second, The key Intmarterial embolectomy using Fogarty catheter is an effective method for the treatment of acute arterial embolism in the extremities, is significant in application. Third, as soon as the diagnosis is established, embolectomy with Forgarty catheter must be carried out to avoid clot extension and necrosis of the extremity. Satisfactory therapeutic efficacy can be got, if the patient receive operation within 48 hours from onset.