数字减影血管造影联合Fogarty球囊导管取栓术在动脉联合血栓中的应用

Application of DSA Combined with Fogarty Balloon Catheter Removal in Arterial Combined Thrombosis

目的比较数字减影血管造影(digital subtraction angiography,DSA)引导下Fogarty球囊导管取栓术、切开探查术在动脉危象联合血栓中应用的效果。方法回顾性分析2012年9月~2020年5月承德医学院附属医院收治的35例在断肢再植术后出现血管危象,经高频超声诊断为联合血栓的患者临床数据。依据手术方式分为微创组(即DSA引导下Fogarty球囊导管取栓术,12例),开放组(即切开探查术,23例),对手术前、中、后各项指标进行比较研究。结果入院时两组一般资料差异均无统计学意义(P>0.05),具有可比性;对血管再通畅时间、术中手术时间、术中出血量进行比较,微创组显著低于开放组(P<0.05);对术后再次栓塞率、术后截肢率进行比较,微创组显著低于开放组(P<0.05);术后9个月随访患肢功能优良率二组间比较,差异无统计学意义(P>0.05);对住院医疗费进行比较,开放组显著低于微创组(P<0.05)。结论DSA引导下Fogarty球囊导管取栓术处理动脉危象联合血栓,可避免断端修复区域二次损伤,并发症发生率低,早期疗效确切,但会增加医疗费用。

Objective To compare the effects of DSA-guided Fogarty balloon catheter removal and incision exploration in the treatment of arterial crisis combined with thrombosis.Methods Analysis rstrospectively the clinical data of 35 cases who had vascular crisis after replantation of severed limbs and diagnosed with combined thrombosis by high-frequency ultrasound from September 2012 to May 2020 in the Affiliated Hospital of Chengde Medical University.According to the surgical method,the cases divided into minimally invasive group(fogarty balloon catheter thrombectomy under DSA guidance,12 cases)and open group(incision and exploratory surgery,23 cases).A comparative study of various indicators before,during and after the operation.Results There was no statistically significant difference in general information between the two groups at admission(P>0.05),and they were comparable;the time to vascular repatency,intraoperative operation time,and intraoperative blood loss in the minimally invasive group were significantly lower than those in the open group(P<0.05);the postoperative re-embolization rate and postoperative amputation rate of the minimally invasive group were significantly lower than those of the open group(P<0.05);there was no significant difference between the two groups in the rate of good limb function at 9 months postoperative follow-up(P>0.05);the hospitalization medical expenses open group was significantly lower than the minimally invasive group(P>0.05).Conclusion DSA-guided Fogarty balloon catheter removal for arterial crisis combined with thrombosis can avoid secondary damage to the repair area of the broken end,with low incidence of complications and definite early curative effect,but will increase medical costs.