经皮经腔介入治疗技术在动脉狭窄性疾病中的应用

Percutaneous transluminal treatment for stenotic and occlusive lesions of artery

目的 探讨局部溶栓、经皮血管成形术 (percutaneoustranscatheteangioplasty ,PTA)和内支架置入术在治疗动脉狭窄或阻塞性疾病的作用。方法 1987年 12月至 1997年 12月间 ,10 5例 115段动脉狭窄或阻塞接受了介入治疗。在 6 3段阻塞中 ,6 1段首选了局部溶栓 ;2段首选了PTA ;在 5 2段狭窄中 ,5 0段首选了PTA ;2段首选了内支架置入 ,这 2段为 2例病人 ,分别为胸腹主动脉交界处假性动脉瘤和腹主动脉夹层。结果 全组总的治疗成功率为 98 3% (113/ 115 ) ,PTA后内支架置入率为19 8% (16 / 81) ,并发症发生率为 1 7% (2 / 115 )。狭窄组和阻塞组的治疗成功率分别为 10 0 0 % (5 2 /5 2 )和 96 8% (6 1/ 6 3) ;PTA后内支架置入率分别为 14 0 % (7/ 5 0 )和 2 9 0 % (9/ 31) ;并发症发生率分别为 0 0 % (0 / 5 2 )和 3 2 % (2 / 6 3)。在阻塞组中 ,首选溶栓和未作溶栓的PTA后内支架置入率分别为2 4 1% (7/ 2 9)和 2 / 2 ;并发症发生率分别为 1 6 % (1/ 6 1)和 1/ 2。结论 经皮经腔技术治疗动脉狭窄性疾病是安全和有效的方法。合理应用局部溶栓、PTA和内支架置入术有助于提高疗效和减少并发症。

Objective To study the effect of the local thrombolysis, PTA, and stent implantation on treating stenotic and occlusive lesions of artery. Methods From December 1987 to December 1997, percutaneous transluminal treatment was performed in 115 lesions of artery (105 patients). Of the 63 occlusions, local thrombolysis was performed in 61 and PTA was taken in 2 as the first step. Of the 52 stenosis, PTA was firstly performed in 50 of them, and stent implantation was done in the other two who suffered from pseudo aneurysm and dissection of abdominal aorta respectively. Results Total success rate was 98.3%(113/115), the rate of stent implantation after PTA was 19.8%(16/81) and complication rate was 1.7%(2/115). The success rate in stenosis and occlusion groups was 100%(52/52) and 96.8%(61/63), the rate of stent implantation after PTA was 14%(7/50) and 29.0%(9/31), and complication rate was 0(0/52) and 3.2%(2/63), respectively. In occlusion group, the rate of stent implantation after PTA with and without performing first local thrombolysis was 24.1%(7/29) and 2/2, respectively, and complication rate was 1.6%(1/61) and 1/2, respectively. Conclusion The percutaneous transluminal treatment was a safe and effective option. Sequent application of local thrombolysis, PTA, and stent implantation can help to improve primary results of treatment and reduce the complication rate.