Fogarty导管取栓术联合多种微创技术治疗急性下肢动脉缺血的疗效

目的 探讨Fogarty导管取栓术联合多种微创技术在治疗急性下肢动脉缺血中的临床应用价值。 方法 回顾性分析2007年2月至2011年1月期间笔者所在医院收治的88例（88条肢体）急性下肢动脉缺血患者的临床资料，比较行Fogarty导管取栓术（取栓组）和行Fogarty导管取栓术联合多种微创技术（联合组）患者手术前后踝-肱指数（ABI）、足趾血氧饱和度（SO2）及足部皮温的改变情况，并比较2组患者术后的死亡率、截肢率及各并发症发生率。结果 取栓组和联合组患者术后的ABI、足趾SO2及足部皮温与同组术前比较均升高（P＜0.05）；2组患者术前ABI、足趾SO2及足部皮温比较差异均无统计学意义（P＞0.05）；术后联合组患者的ABI、足趾SO2、足部皮温及其改变值较取栓组均升高 （P＜0.05）。术后取栓组患者的死亡率、截肢率、肌病肾病代谢性综合征（MNMS） 发生率、骨筋膜室综合征发生率及一过性肾功能不全发生率分别为13.04% （6/46）、17.39% （8/46）、26.09% （12/46）、26.09% （12/46）及13.04% （6/46），联合组分别为4.76% （2/42）、7.14% （3/42）、14.29% （6/42）、9.52% （4/42）及9.52% （4/42），取栓组各指标均较高（P＜0.05）。结论 Fogarty导管取栓术联合多种微创技术具有手术微创性、治疗有效性等特点，可作为急性下肢动脉缺血的外科治疗方法之一。

The Effect of Fogarty Catheter Embolectomy Combined with Multiple Minimally Invasive Techniques for Acute Limb Ischemia

Objective To investigate the significance of Fogarty catheter embolectomy combined with multiple minimally invasive techniques for acute limb ischemia. Methods Clinical data of 88 cases （88 limbs） of lower limb ischemia who were treated in our hospital from Feb. 2007 to Jan. 2011 were collected and analyzed. Of the 88 patients,46 cases were operated by Fogarty catheter embolectomy （embolectomy group）, 42 cases were operated by Fogarty catheter embolectomy combined with multiple minimally invasive techniques （combination group）. Comparisons of the clinical indexes of ankle-brachial index （ABI）, saturation of blood oxygen （SO2） of toes, and temperature of foot skin before and after operation were performed between the 2 groups, as well as the incidence of mortality, complication, and amputation after operation. Results Compared with before operation in the same group, the value of ABI, SO2, and temperature of foot skin in the 2 groups were higher （P〈0.05）, as well as the 3 kinds of indexes were both higher in combination group after operation （P〈0.05）. The rates of mortality, amputation, myonephropathic metabolic syndrome （MNMS）, osteofascial compartment syndrome, and transient renal insufficiency were 13.04% （6/46）, 17.39% （8/46）, 26.09% （12/46）, 26.09% （12/46）, and 13.04% （6/46） respectively, the corresponding rates in combination group were 4.76% （2/42）, 7.14% （3/42）, 14.29% （6/42）, 9.52% （4/42）, and 9.52% （4/42） respectively, which were all lower in combination group （P〈0.05）. Conclusion Fogarty catheter embolectomy combined with multiple minimally invasive techniques can be one of the surgical treatment methods for acute limb ischemia, which is characterized by minimally invasive surgery and effective treatment.