肢体军训伤后继发动脉血栓形成的血管腔内治疗

Endovascular treatment for arterial thrombosis of extremities caused by military training injuries

目的探讨应用导管接触溶栓(catheter-directed thrombolysis,CDT)治疗肢体军训伤后继发动脉血栓形成的临床效果。方法回顾性分析2005年3月至2013年3月中国人民解放军第一〇七医院血管外科收治的43例四肢军训伤后继发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1例,Ⅱa级23例,Ⅱb级15例,Ⅲ级4例。患者均接受CDT治疗,其中单纯CDT 22例,CDT+腔内球囊扩张成形(percutaneous transluminal angioplasty,PTA)17例,CDT+PTA+支架置入4例。结果本组导管溶栓时间为1~7天,平均(3±2)天。根据术中血管造影及术后随访结果,治愈32例(74.4%),Ⅰ级1例,Ⅱa级21例,Ⅱb级9例,Ⅲ级1例。其中单纯CDT 22例,CDT+PTA 6例,CDT+PTA+支架置入4例;有效11例(25.6%),Ⅱa级2例,Ⅱb级6例,Ⅲ级3例。均施行CDT+PTA治疗。2例(4.7%)溶栓过程中发生二次栓塞予调整导管位置后继续溶栓,5例(11.6%)溶栓过程中发生小腿骨筋膜室综合征行骨筋膜室切开减压术,均保趾、保肢成功。43例(100.0%)均行术后随访;随访时间12~108个月,平均(48±19)个月。所有患者均无症状加重或复发。结论 CDT治疗四肢军训伤后继发动脉血栓形成是一种安全、有效、微创的方法,适宜于战时伤病员的救治与后送。

Objective To evaluate the effect of treatment of catheter-directed thrombolysis(CDT)for arterial thrombosis of extremities caused by military training injuries.Methods From March2005to March2013,the clinical data of43patients(43limbs)with arterial thrombosis of extremities caused by military training injuries treated by CDT were analysed retrospectively.According to Rutherford Criteria:Ⅰ1cases,Ⅱa23cases,Ⅱb15cases,Ⅲ4cases.All of the cases underwent CDT with different procedures,including pure CDT(22cases),CDT+percutaneous transluminal angioplasty(PTA)(17cases),CDT+PTA+stent implantation(4cases).Results The CDT period was1~7days with mean time of(3±2)days.Upon the results of angiography and following-up,32cases(74.4%)were cured by pure CDT(22cases),CDT+PTA(6cases)and CDT+PTA+stent implantation(4cases),includingⅠ1cases,Ⅱa21cases,Ⅱb9cases,Ⅲ1case;11cases(25.6%)received effective results treated by CDT+PTA,includingⅡa2cases,Ⅱb6cases,Ⅲ3cases.5cases(11.6%)underwent open decompression of compartment and the extremities were saved.43cases(100.0%)were followed-up with mean time of(48±19)months,ranging from12to108months and reported satisfactory results.No“garbage foot”occurred in this group.Conclusion CDT is a safe,effective and minimally-invasive treatment for arterial thrombosis of extremities caused by military training injuries.