经皮机械血栓清除术治疗下肢动脉狭窄伴血栓形成病变的近期疗效观察

Short-term result of percutaneous mechanical thrombectomy for treating artery stenosis disease accompanied with thrombosis of lower extremity

目的:评价经皮机械血栓清除术(PMT)治疗下肢动脉狭窄伴血栓形成病变的有效性及安全性。方法:选取初始治疗应用减容治疗方法的下肢动脉狭窄伴血栓形成患者共102例。按减容方法不同,分为经皮机械血栓清除联合置管溶栓(PMT+CDT)组(27例)及单纯置管溶栓组(CDT)组(75例)。减容治疗后视治疗结果给予经皮腔内血管成形术(PTA)+支架置入等后续处理。对比两组一般情况、术中情况(失血量、造影剂用量)、围手术期情况(尿激酶用量、介入次数、减容时间、减容相关并发症)、减容有效性、减容费用、踝肱指数(ABI)、术后6个月再狭窄等情况。结果:两组患者术前一般情况无统计学差异(P>0.05);PMT+CDT组减容有效性显著高于CDT组(P<0.05);同组内比较,两组术后1周及6个月ABI均显著高于术前(P<0.05);两组间同时点比较,ABI无统计学差异(P>0.05);两组在术后6个月再狭窄率方面无统计学差异(P>0.05),但在支架内再狭窄病例亚组中PMT+CDT组的6个月再狭窄率显著低于CDT组(P<0.05);PMT+CDT组的造影剂用量、介入次数、尿激酶用量、减容时间以及减容相关并发症发生率显著低于CDT组(P<0.05),失血量、减容费用显著高于CDT组(P<0.05)。结论:经皮机械血栓清除术有效、省时、安全,可作为下肢动脉狭窄伴血栓形成患者的首选初始治疗方法。

Objective：To evaluate the efficacy and safety of percutaneous mechanical thrombectomy（PMT） for treating artery stenosis disease accompanied with thrombosis of lower extremity. Methods： One hundredand two patients with artery stenosis disease accompanied with thrombosis of lower extremity were enrolled in this study, who were given debulking treatment as primary treatment . The patients were divided into 2 groups,PMT combined with catheter directed thrombolysis （PMT＋CDT） group（n=27） and catheter directed thrombolysis（ CDT） group （n =75）. After that, the patients were treated with subsequent relative methods according to the result of the debulking treatment, including percutaneous transluminalangioplasty（PTA） and stent placement. The general conditions of individuals, intraoperative conditions （including blood loss of the operation, total dose of contrast media）, perioperative conditions （including total dose of urokinase, period of debulkingtreatment ,times of intervention, complications of debulking treatment） ,efficacy of debulking treatment, cost of debulking treatment, ankle-brachial index （ABI） ,rate of restenosis of six months post-operation were compared between two groups. Results： There were no statistically significant differences in general conditions between the two groups（P〉0.05）. The efficacy of debulking treatment was significantly more effective in PMT＋CDT group （P〈0.05. At the same time point of pre or post operation , there were no significant differences in ABI between 2 groups （P〉0.05）. ABI for a week and six months post-operation were higher than ABI preoperation in the same group （P〈0.05=. There was no statistically significant difference in the rate of restenosis of six months post-operation. The rate of restenosis of six months post-operation in subgroup of in-stent restenosis was analyzed, which revealed that the rate of PMT＋ CDT group was significantly lower（P〈0.05=. Compared with CDT group, times of intervention, total dose of contrast media, total dose of urokinase, time of debulking treatment, complications of debulking treatment were significantly decreased in PMT＋ CDT group（P〈0.05）,but the cost of debulking treatment and blood loss in the operation were significantly higher（P〈0.05）. Conclusion： PMT＋CDT,which is significantly effective, safe and time-saving , could be a preferred therapy in the primary treatment of arterial stenosis disease accompanied with thrombosis of lower extremity.