Fogarty球囊导管在断肢再植术后联合血栓中的应用

Application of Fogarty balloon catheter in the combined thrombus after replantation of limb

目的观察Fogarty球囊导管在断肢再植术后联合血栓中应用的疗效。方法回顾性探讨2010年1月至2016年1月承德医学院附属医院收治的Fogarty球囊导管处理联合血栓的19例患者资料,栓塞位置:右侧8例,左侧11例;足背动脉3例,胫后动脉8例,尺动脉2例,肱动脉2例,桡动脉4例。再植术后临床表现符合联合血栓的病例,应用彩色多普勒超声确诊,患者术中取仰卧位,先利用Fogarty球囊导管取出动脉中的血栓,血管出现喷血(搏动性)即可,随后在动脉切口处留置Fogarty导管,注入尿激酶盐水、肝素盐水,将残留的血栓溶解。术后17例成活,观察患肢活动度、血运及感觉等指标。术后3.5~9.5 h,2例再次出现联合血栓动脉危象,予以彩超定位血栓,应用切开探查术式处理,1例血管危象救治成功,1例足部坏死,行截肢术。结果所有病例均未发生伤口感染、空气栓塞及血管穿孔等并发症,取出的血栓平均长度2.7 cm(0.4~4.3 cm)。2例改行切开探查术式处理的患者,不纳入疗效评价,剩余17例患者均严格随访,平均随访时间16个月(10~32个月),患肢外形满意,皮肤颜色正常,肿胀度、活动度明显改善,血运显著改善,毛细血管充盈时间1~4 s,皮肤温度较患肢低1~2℃或正常,感觉平均位于S_3级(S_1~S_4级),两点辨别觉平均5 mm(4~9 mm)。参照断肢再植功能评定试用标准评价疗效,差2例、良4例、优11例,优良率88.2%。结论应用Fogarty球囊导管处理联合血栓,可避免血管吻合口区域二次损伤,临床疗效肯定。

Objective To observe the effect of Fogarty balloon catheter in the combined thrombus after replantation of limb.Methods The data of 19 patients（ 6 females and 13 males） with combined thrombus treated with Fogarty balloon catheter with in Chengde Medical College Affiliated Hospital from January 2010 to January 2016 were retrospectively analyzed. The embolization positions were as follows： 8 cases on the right side,11 cases on the left side,3 cases of dorsal artery,8 cases of posterior tibial artery,2 cases of ulnar artery,2 cases of radial artery and 4 cases of radial artery. The re-implantation patients whose clinical manifestations were consistent with combined thrombosis were confirmed by color Doppler ultrasound for perioperative management. The patient was placed in the supine position. The Fogarty balloon catheter was used to remove the thrombus in the artery; if the blood vessel was spurted（ pulsating）,the Fogarty catheter was placed in the artery incision,and the urokinase saline and heparin saline were injected to dissolve the residual thrombus. Seventeen patients survived after surgery,and the indicators of activity,blood supply and sensation were observed. From3. 5 h to 9. 5 h after operation,two cases of combined thrombotic vascular crisis occurred again,and the color Doppler was applied to locate the thrombus and exploratory operation was applied for the management. One case of vascular crisis was successfully treated,while the other one case had foot necrosis and amputation was performed. Results Complications such as vascular perforation,air embolism and wound infection did not occur in all cases,and the average length of thrombus removed was 2. 7 cm（ 0. 4 cm to 4. 3 cm）. Two patients who underwent exploration were not included in the evaluation of efficacy,and the remaining 17 patients were followed up closely;the average follow-up time was 16 months（ 10 months to 32 months）. The shape of the affected limb was satisfactory,the skin color was normal,and the degree of swelling,activity and blood supply were significantly improved. Capillary filling time was 1 s to 4 s,skin temperature of normal limb was lower than the affected limb at 1 ℃ to 2 ℃ or normal,the average feeling was located in S3（ S1 to S4）,and two-point discrimination on average was 5 mm（ 4 mm to 9 mm）. According to the Chinese Medical Association Hand Surgery Branch,the evaluation criteria for the evaluation of the limb replantation function were adopted. The group was excellent in 11 cases,good in 4 cases,and poor in 2 cases. The excellent and good rate was 88. 2%. Conclusion The use of Fogarty balloon catheter to treat combined thrombus can avoid secondary injury in the vascular anastomotic region,and the clinical efficacy is positive.