下肢动脉硬化性闭塞症介入治疗围手术期并发症分析

Perioperative complications of interventional therapy for lower extremity arteriosclerosis obliterans

目的总结下肢动脉硬化性闭塞症介入治疗围手术期相关并发症的防治经验。方法对207例下肢动脉硬化性闭塞症行介入治疗，统计围手术期各种并发症的发生情况，分析并发症的发生率与泛大西洋介入协会（transAtlantic inter—society consensus，TASC）分型分级之间的关系以及糖尿病和冠心病对重要脏器并发症发生率的影响。结果本组207例，介入手术成功190例。17例失败，其中13例为介入操作失败、4例死于术后重要脏器并发症。围手术期并发症包括穿刺点出血12例、假性动脉瘤4例、消化道出血2例、动脉破裂6例、脑梗塞8例、急性心衰9例、呼衰13例、肾衰6例、支架内血栓形成5例和蓝趾综合征1例。在本组患者的TASC分型中，股胭动脉病变介入治疗并发症的发生率为39．84％（51／128），高于主髂型的18．99％（15／79）（P〈0．05）；患有糖尿病以及合并糖尿病和冠心病患者重要脏器并发症的发生率分别为27．66％（13／47）和24．49％（12／49），高于无合并症患者的5％（2／40）（P〈0．05）。结论下肢动脉硬化性闭塞症介入治疗围手术期并发症发生率较高可能与术中操作不当、病变类型复杂及合并糖尿病和冠心病有关，术前注意合并症的处理及术中选择合理治疗方式、缩短手术时间等可减少并发症的发生。

Objective To evaluate the prevention and management for the complications in interventional therapy for the lower extremity arteriosclerosis obliterans （ASO）. Methods In this study 207 ASO cases received interventional therapy. The relationship between complication rates and different TASC type and the influence of diabetes mellitus （ DM ） with coronary heart disease （ CHD ） on critical organs complication rates was analyzed. Results The intervention succeeded in 190 cases. There was 17 failures, including 13 procedure failures and 4 deaths due to postoperative critical organ complications. Among the complications there were puncture site hemorrhage in 12, pseudoaneurysm in 4, alimentary tract hemorrhage in 2, arteriorrhexis in 6, cerebral infarction in 8, acute heart failure in 9, respiratory failure in 13, renal failure in 6, thrombosis in 5 and blue-toe syndrome in 1. The intraoperative complication rate of femoral-political type （ 39. 84%, 51/128 ） was high than that of aorta-lilac type （ 18.99%, 15/79） （ P 〈 0.05）. Those critical organ complication rates of patients with DM and patients with DM＆CHD were 27.66% （ 13/47 ） and 24.49% （ 12/49 ） respectively, they were higher than that of patients without （5 %, 2/ 40） （P 〈 0. 05 ）. Conclusions The high complication rates during interventional therapy of ASO were because of misoperation and complicated pathological type and together with DM and CHD. These rates could be decreased when we treated DM and CHD before operation and chosen a reasonable method and shorten the duration of operation.