杂交手术在治疗肢体动脉栓塞疾病中的应用

The application of hybrid technique in treating arterial embolism of limbs

目的探讨DSA下采用杂交手术（动脉切开取栓联合腔内治疗）治疗肢体动脉栓塞的临床效果。方法2011年6月-2013年6月对82例91条（上肢8条，下肢83条）肢体动脉栓塞患者采用杂交手术进行治疗。术中常规行肢体动脉造影，导丝通过栓塞部位，沿导丝送入Fogarty导管进行单纯取栓或球囊辅助下取栓，术后根据复查造影结果．选择联合应用腔内置管溶栓术、球囊扩张成形术或支架植入术。术后随访3～36个月，观察患肢缺血症状改善情况、保肢率等。结果82例患者共91条肢体均手术成功，其中球囊辅助下取栓6条，取栓后联合置管溶栓24条，联合球囊扩张成形术11条，联合支架植入术4条。术后保全肢体76条，保肢率83．5％，遗留功能障碍11条，肢体完全康复65条，占71.4％，死亡7例。随访期间原病变血管血流保持通畅。结论杂交技术治疗肢体动脉栓塞有较高的保肢率和治愈率，效果良好。

Objective To evaluate the clinical effect of the hybrid technique, i.e. arteriotomic thrombectomy together with endovascular therapy, in treating arterial embolism of limbs. Methods During the period from June 2011 to June 2013 at authors＇ hospital, hybrid operation was carried out in 82 patients with arterial embolism of limbs. A total of 91 diseased limbs, including 8 upper limbs and 83 lower limbs, were treated. Arterial angiography of the extremity was routinely performed first, which was followed by catheterization. After the guild-wire passed through the clot a Fogarty catheter was inserted along the guildwire, and under DSA monitoring embolectomy or balloon-assisted thrombectomy was performed. Based on the postoperative angiography findings, transcatheter thrombolysis, balloon angioplasty and/or stenting were employed. All the patients were followed up for 3 - 36 months. The improvement of limb ischemia and the limb salvage rate were analyzed. Results Hybrid operation was successfully performed in all patients. The procedures included balloon-assisted embolectomy （n = 6）, transcatheter thrombolysis following emboleetomy （n = 24）, balloon angioplasty following embolectomy （n = 11 ） and stenting following embolectomy （n = 4）. Limb salvage rate was 83.5% （76/91）, leaving dysfunction in 11 limbs. Complete recovery was obtained in 65 limbs （71.4%）, and 7 patients died during perioperative period. During the follow-up period, the previously diseased arteries remained patent. Conclusion For the treatment of limb arterial embolism, the hybrid operation has higher limb salvage rate and cure rate.