经皮机械性血栓清除联合导管溶栓与单纯导管溶栓治疗急性下肢缺血的疗效比较

Comparison of catheter-directed thrombolysis with and without percutaneous mechanical thrombectomy for acute lower limb ischemia

目的比较PMT联合CDT与单纯CDT治疗急性下肢缺血的临床疗效。方法回顾性分析2017年1月至2018年12月苏州大学附属第一医院收治的64例急性下肢缺血患者的临床资料,其中24例行PMT联合CDT治疗(PMT组),40例行单纯CDT治疗(CDT组)。比较两组手术成功率、尿激酶用量、手术时间、溶栓时间、住院时间、住院期间并发症发生率和术后30 d内截肢率、再次手术率及死亡率。结果两组手术均取得成功,技术成功率为100%;PMT组和CDT组的尿激酶用量分别为(56.67±8.16)万U和(106.50±47.56)万U,手术时间分别为(103.33±25.57)min和(72.13±25.74)min,溶栓时间分别为(24.96±12.52)h和(61.20±29.24)h,住院时间分别为(7.13±2.52)d和(9.35±2.65)d,差异均有统计学意义(P<0.01)。两组住院期间并发症发生率(16.7%vs 17.5%)、术后30 d内截肢率(12.5%vs15.0%)、再次手术率(4.2%vs 7.5%)及死亡率(8.3%vs 2.5%)差异均无统计学意义(P>0.05)。不同缺血时间患者的缺血改善情况,两组比较差异均无统计学意义(P>0.05)。结论采取PMT联合CDT治疗急性下肢缺血患者在手术疗效、并发症发生情况结果和单纯CDT相似,但可降低溶栓药物用量、缩短溶栓时间和住院时间。

Objective To compare the efficacy of catheter-directed thrombolysis(CDT)with and without percutaneous mechanical thrombectomy(PMT)in the treatment of acute lower limb ischemia(ALLI).Methods The clinical date of 64 patients with ALLI who underwent CDT with or without PMT between January 2017 and December 2018 in our hospital were reviewed retrospectively.24 patients in PMT group were underwent PMT and CDT,while 40 patients in CDT group were underwent CDT alone.The surgical technique success rate,urokinase dosage,operation time,thrombolysis time,hospitalization time,complication rate during hospitalization,re-intervention rate,amputation rate and mortality within 30 days were calculated Results The technical success rate was 100%.The urokinase dosage,operation time,thrombolysis time and hospitalization time in the PMT group and the CDT group were(56.67±8.16)U and(106.50±47.56)U,(103.33±25.57)min and(72.13±25.74)min,(24.96±12.52)h and(61.20±29.24)h,(7.13±2.52)d and(9.35±2.65)d,respectively.The difference was statistically significant(P<0.01).The incidence of complications during hospitalization(16.7%vs 17.5%),amputation rate within 30 days after surgery(12.5%vs 15.0%),reoperation rate(4.2%vs 7.5%)and mortality(8.3%vs 2.5%)were no significant difference between PMT group and CDT group(P>0.05).There was no significant difference for improvement of ischemia in patients with different ischemic time(P>0.05).Conclusion PMT with CDT in the treatment of ALLI has a similar effect in surgical outcomes and complications,however,it can reduce the thrombolytic drug dosage,shorten thrombolysis time and hospitalization time.