肢体外伤后继发动脉血栓形成的腔内治疗

Catheter-directed Thrombolysis for Arterial Thrombosis of Extremities Caused by Trauma

目的：探讨导管接触溶栓（ catheter-directed thrombolysis， CDT）治疗四肢外伤后动脉血栓形成的效果。方法回顾性分析2005年3月～2013年3月152例四肢外伤后动脉血栓形成患者应用CDT治疗的临床资料。 Rutherford急性肢体缺血分级，Ⅰ级2例，Ⅱa级83例，Ⅱb级52例，Ⅲ级15例。单纯CDT 89例，CDT＋腔内球囊扩张成形（ percutaneous transluminal angioplasty，PTA）51例，CDT＋PTA＋支架置入12例。结果导管溶栓时间1～7 d，（4．0±1．5） d。随访时间12～108个月，（50±22）月。根据术中血管造影及术后随访结果，治愈105例（69．1％），其中Ⅰ级2例（100％，2／2），Ⅱa级77例（92．8％，77／83），Ⅱb级24例（46．2％，24／52），Ⅲ级2例（13．3％，2／15）；有效30例（19．7％），其中Ⅱa级6例（7．2％，6／83），Ⅱb级19例（36．5％，19／52），Ⅲ级5例（33．3％，5／15）；无效17例（11．2％），其中Ⅱb级9例（17．3％，9／52），Ⅲ级8例（53．3％，8／15），其中住院期间截肢15例（9．9％）。5例（3．3％）溶栓过程中发生二次栓塞，调整导管位置后继续溶栓；23例（15．1％）术后小腿骨筋膜室综合征，行骨筋膜室切开减压术，均保肢成功。2例二期截肢，余无症状加重或复发。结论CDT治疗四肢外伤后动脉血栓形成是一种安全、有效、微创的方法。

Objective To evaluate the effects of catheter-directed thrombolysis （ CDT） for arterial thrombosis of extremities caused by trauma. Methods Clinical data of 152 patients （152 limbs） with arterial thrombosis of extremities caused by trauma treated by CDT from March 2005 to March 2013 were analyzed retrospectively.According to the Rutherford Criteria, there were 2 cases of gradeⅠ, 83 cases of grade Ⅱa, 52 cases of grade Ⅱb, and 15 cases of grade Ⅲ.All the cases underwent different CDT procedures, including simple CDT （89 cases）, CDT and percutaneous transluminal angioplasty （PTA） （51 cases）, CDT and PTA with stent implantation （12 cases）. Results The time of CDT was 1-7 days, with a mean of （4.0 ±1.5） days.Upon the results of angiography and following-up examinations [12 -108 months,mean, （50 ±22） months], 105 cases （69.1%） were cured, including 2 gradeⅠcases （100%, 2/2）, 77 gradeⅡa cases （92.8%, 77/83）, 24 gradeⅡb cases （46.2%, 24/52）, 2 gradeⅢcases （13.3%, 2/15）.A total of 30 cases （19.7%） received effective results, including 6 grade Ⅱa cases （7.2%, 6/83）, 19 gradeⅡb cases （36.5%, 19/52）, 5 gradeⅢcases （33.3%, 5/15）.There were 17 ineffective cases （11.2%）, including 9 gradeⅡb cases （17.3%, 9/52） and 8 gradeⅢcases （53.3%, 8/15）.A one-stage amputation was performed in 15 cases （9.9%）, and 23 cases （15.1%） underwent open decompression of compartment with their extremities saved.Followed-up observations reported satisfactory results with normal life after operation, except for 2 cases of amputation.No recurrence was seen in this group. Conclusion The CDT is a safe, effective and minimally-invasive treatment for arterial thrombosis of extremities caused by trauma.