1620例次外周血管介入治疗围手术期严重并发症的分析

Significant complications occurred in the perioperative period of peripheral vascular interventions:an analysis of 1620 consecutive procedures

目的分析在外周血管介入诊治中出现的严重并发症类型、发生原因、处置及结局,以提高认识和处理严重并发症的能力。方法回顾性分析近5年来在1620例次外周血管介入诊治中所出现的严重并发症,每种并发症的发生率,发生后给予的处置,以及最后结局。结果在1620例次介入诊治中,在术中及术后1周内出现严重并发症共76例次,发生率为4.69%。出现的严重并发症达12种。大部分经处理后恢复正常,未遗留后遗症。部分患者遗留永久性合并症,如截瘫、下肢瘫痪、臀部肌肉坏死等。6例患者死亡。在死亡的6例患者中,4例同时发生肝功能衰竭及粒细胞缺乏症,1例死于腹膜后血肿及腹腔积血,1例死于肺栓塞。结论①多数外周血管介入治疗均可能出现严重并发症,这些并发症的发生大部分与术者对疾病的认识水平低和操作失当相关。②具备良好的基础知识、基本理论和基本技能,慎重选择介入治疗的适应证,细心操作,是减少介入治疗中严重并发症发生的关键。

Objective To categorize the significant complications occurred in the perioperative period of peripheral vascular interventions and to analyze their causes,outcomes and managements in order to make a further understanding of the cause of occurrence and to improve the handling ability.Methods Over the past five years a total of 1620 consecutive peripheral vascular interventions were carried out in our institute.Significant complications,which occurred in the perioperative period,and the clinical data were carefully examined.The occurrence,treatment,consequence and final outcome of each complication were retrospectively analyzed.Results Of 1620 consecutive peripheral interventional procedures,significant complication which developed during the operation or within one week after the treatment was seen in 76（4.69%）.The significant complications could be classified into twelve kinds.After proper management most complications were cured without leaving any sequelae.Nevertheless,in some patients permanent damages such as paraplegia,lower limb paralysis,necrosis of gluteus,etc.were left over.Death occurred in six patients.Of the six patients,four died of concomitant hepatic failure and agranulocytosis,one of retroperitoneal hematoma and hemoperitoneum,and another one of pulmonary embolism.Conclusion（1） Significant complications may occur in most peripheral vascular interventional therapies,which,in most cases,are mainly related to the insufficient understanding of the disease and improper manipulation.（2） A comprehensive and solid fundamental knowledge of the disease,strictly following the indications and careful handling the operation are the key points to reduce the occurrence of severe complications in the perioperative period of peripheral vascular interventions.