4取栓术治疗肢体动脉栓塞30例

急性肢体动脉栓塞是血管外科的常见急症,其特点是发病急,伤残率高,如何减少手术取栓后的再栓及损伤至关重要.我院近年应用中西医结合综合疗法,治疗急性下肢动脉栓塞30例,取得了较好效果,现报告如下.     

取栓术治疗肢体动脉栓塞30例

急性肢体动脉栓塞是血管外科的常见急症,其特点是发病急,伤残率高,如何减少手术取栓后的再栓及损伤至关重要.我院近年应用中西医结合综合疗法,治疗急性下肢动脉栓塞30例,取得了较好效果,现报告如下.     

肺动脉切开取栓治疗急性巨块性肺动脉栓塞

目的探讨急性巨块性肺动脉栓塞的外科治疗。方法对3例经多排螺旋CT确诊、保守治疗无效并发呼吸衰竭及右心功能不全的急性肺动脉栓塞患者行肺动脉切开取栓术,术后早期应用肝素,后期应用华法林抗凝治疗。结果3例患者术后均存活,术后心功能由Ⅳ级改善为Ⅰ～Ⅱ级,出院后随访6-24个月未发生再栓塞。结论多排螺旋CT可作为确立急性肺动脉栓塞诊断的依据;适时的手术决策是提高手术疗效的关键。     

肺动脉多发栓塞体外循环下取栓术1例

病人　男 ,35岁。左下肢脉管炎 6年 ,逐渐出现呼吸困难。 2 0 0 2年 6月 ,因突发呼吸困难加重 ,急诊入我院呼吸内科。Ｘ线胸片示双肺纹理增强并紊乱 ,右肺门影稍大。螺旋ＣＴ检查怀疑肺动脉栓塞。心脏超声心动图提示 :右房、右室扩大 ,疑右心室粘液瘤 ;三尖瓣重度关闭不全 ;肺动脉高压。血气分析 :ＰａＯ2 86ｍｍＨｇ(1ｍｍＨｇ=0 133ｋＰａ)。心电图示窦性心动过速。经内科治疗无效且病情加重 ,转入心胸外科。查体 :呼吸 2 5次 /ｍｉｎ ,心率 12 0次 /ｍｉｎ ,血压 110 / 75ｍｍＨｇ。双肺呼吸音减弱 ,闻及散在的干、湿性罗音。左下肢小腿…     

用Fogarty气囊导管取栓治疗四肢动脉栓塞的国内现状

用Ｆｏｇａｒｔｙ气囊导管取栓治疗四肢动脉栓塞的国内现状戴显伟四肢动脉，以及腹主动脉下段（端）及骼动脉的栓塞，可迅速引起肢体远端严重缺血，如不及时治疗，轻者造成肢体坏死导致截肢，重者危及生命。因此，充分认识本清，做到及时确诊和合理有效的治疗，是挽救肢体...     

肢体动脉取栓后再栓塞13例防治分析

肢体动脉取栓后再栓塞１３例防治分析上海第二医科大学附属第九人民医院（２０００１１）田卓平黄新天李维敏蒋米尔陆民张培华我院１９８３年４月至１９９６年１１月收治取栓术后再栓塞病人１３例，处理棘手，现就其诊治体会报告如下。１临床资料１９８３年４月至１９９６...     

颅内动脉机械取栓装置取栓研究

目的 观察国产颅内动脉机械装置取栓的有效性及安全性.方法 临时阻断颈总动脉血流并注入凝血酶制作60只适合机械取栓的兔急性血管栓塞模型,按随机数字表法分为非治疗组、3h溶栓组、3、6、8、12h取栓组,取栓组应用颅内动脉机械取栓装置取栓,3h溶栓组应用尿激酶溶栓,取、溶栓前后行数字减影血管造影(DSA)观察血管再通,行经颅多普勒(TCD)记录大脑中动脉平均流速(VMCA)变化,行磁共振弥散成像(MR-DWI)描述不同时段取栓表观弥散系数(ADC)的变化.结果 3h取栓、溶栓组的血管再通率分别是80％、20％,差异有统计学意义(P＜0.05),治疗后VMCA的差异有统计学意义(P＜0.05);非治疗组、12 h取栓组ADC值逐渐降低,而3、6、8h取栓组ADC值逐渐上升;栓塞后24 h与非治疗组和12h取栓组比较,3、6、8h取栓组ADC值较高,差异均有统计学意义(P＜0.05).结论 颅内动脉取栓装置取栓有效地提高了闭塞血管的再通率,迅速恢复血流,适当延长了血管内治疗的时间窗.     

导管取栓加灌注蝮蛇抗栓酶治疗急性动脉栓塞47例报告

作者采用Ｆｏｇａｒｔｙ导管取栓辅以术中动脉内灌注国产蝮蛇抗栓酶的方法，治疗急性动脉栓塞４７例，４３例有效，３５例保全了肢体。此法不但能取除主干动脉内的栓子，在一定时间还能保持动脉内高浓度的溶栓抗凝剂，从而有可能达到溶解残留血栓和防止继发血栓形成的目的。本组无手术死亡，术后无大出血和肝肾中毒性损害等并发症。提示此法安全可靠。     

下肢深静脉血栓手术取栓与介入取栓疗效的比较研究

目的比较手术取栓与介入取栓对下肢深静脉血栓形成(deep vein thrombosis,DVT)的近、远期疗效。方法回顾分析2000年3月~2008年8月167例混合型和中心型DVT的临床资料,其中手术取栓87例,介入取栓80例,术后均局部应用尿激酶溶栓、肝素抗凝治疗,后期应用华法林抗凝6~12个月。结果治疗后介入组双大腿及小腿周径差中位数分别为0.8cm(-3.0~6.0cm)和0.7cm(0.0~5.5cm),手术组分别为1.6cm(0.0~8.0cm)和1.1cm(0.0~4.5cm)(Z=-3.932,P=0.000;Z=-3.313,P=0.001)。介入组住院时间(7.7±4.9)d,显著短于手术组(14.7±6.5)d(t=7.806,P=0.000)。介入组腹膜后血肿、肺部感染、伤口感染、淋巴漏等总的并发症发生率为8.8%(7/80),显著低于手术组35.6%(31/87)(χ2=17.135,P=0.000)。131例随访(47.3±28.3)月,2组大、小腿周径差,主观症状评分,色素沉着,静脉曲张,间歇跛行发生率等方面均无显著差异(P0.05)。结论手术取栓与介入取栓相比,远期疗效相当,但介入取栓对于混合型和中心型DVT的治疗时间窗宽,近期疗效更佳,且住院时间短,并发症少。     

急性颅内静脉窦血栓机械取栓1例

正患者女,23岁,因"突发头痛、头晕10天伴左侧肢体活动障碍5天"入院;10天前曾就诊于当地医院,因头部CTA/CTV示上矢状窦闭塞(图1A)而接受抗凝治疗,病情未见明显改善;5天前于当地医院复查头部CT平扫提示右侧中央区脑出血(图1B)。患者1年前曾因"左下肢静脉血栓形成"接受治疗,具体不详。查体:嗜睡,言语清楚;左侧肢体肌张力降低(上肢肌力2级,下肢肌力4级)。DSA示上矢状窦后部及右侧横窦闭塞     

Intra-arterial thrombolysis and thrombectomy for acute ischemic stroke: technique and results

Endovascular intraarterial (IA) strategies have emerged as important treatment options for patients with acute ischemic stroke who are ineligible for intravenous (IV) tissue plasminogen activator (tPA) or in whom such therapy has failed. The goal of this article is to provide a comprehensive review of percutaneous IA endovascular techniques aimed at revascularization in the setting of acute ischemic stroke from IA thrombolysis, mechanical thrombectomy, and primary intracranial stenting to retrievable-stent technology. For each modality, we focus on the existing clinical data, including our institutional experience and techniques.     

Ambulatory thrombectomy of a graft. Transcutaneous clamping

Thrombectomy of a graft in ambulatory patients can be performed simply under local anesthesia, avoiding admission to hospital of patients with shunts. The technique is applicable to two types of shunt: arterio-arterial shunts for lower limb arteriopathy and arteriovenous shunts of a dialysis for chronic renal failure. The advantages are twofold: dissection of a subcutaneous graft is avoided and the patient can either immediately reinstitute activity if arteritic or dialysis for renal failure. The method is effective if the thrombus is of accidental origin, failures resulting from proximal or distal stenosis, their evaluation being possible during thrombectomy.     

Catastrophic paradoxical embolus after hemodialysis access thrombectomy in a patient with a patent foramen ovale

We present the first case of documented clot in-transit through a patent foramen ovale (PFO), caused by mechanical thrombectomy of a clotted AV fistula. Embolus after access thrombectomy is a rare, but known complication of the procedure. Paradoxical embolus is likewise a rare consequence of a right-sided clot, embolising to the left-sided circulation in a patient with a PFO. Suspected embolus through a PFO after dialysis access thrombectomy has been reported, but no case has ever documented the clot in-transit through the PFO.     

A model for assuring clamping success during laparoscopic partial nephrectomy with segmental renal artery clamping

Objectives

A model for assuring clamping success was established for laparoscopic partial nephrectomy (LPN) with segmental renal artery clamping (SRAC).

Materials and methods

Patients (n = 107; December 2009–September 2011) who underwent LPN with SRAC dependent on the experience of the surgeon and CTA were retrospectively reviewed to determine the optimal characteristics of target arteries. After multiple logistic regression analysis, variables used to build a nomogram were selected using a backward elimination scheme. A model for a clamping program customized to the patient was designed. The surgical outcomes of patients (n = 141; October 2011–June 2014) who subsequently underwent LPN-SRAC with the applied model were compared with those of the first group of patients.

Results

Five potential predictors were initially assessed: segmental renal artery angle, target artery diameter, and distance (d) to the abdominal aorta, renal hilum (d _RH), and kidney midline (d _KML). The regression equation was set up as:

$${\text{Clamping assurance}} = \frac{{{\text{e}}^{x} }}{{1 + {\text{e}}^{x} }},\quad {\text{where}}\,x = 12.360 + 4.863\left( {d_{\text{RH}} } \right) - 8.848\left( {d_{\text{KML}} } \right).$$

Comparing the patient groups, those for whom the new SRAC model was applied had a significantly better success rate of clamping (P < 0.001), less total operative time (P < 0.001), and less operative blood loss (P = 0.042). No obvious differences were observed in time of warm ischemia, postoperative hospitalization, RENAL nephrometry score, or number of final clamped branches.

Conclusions

The model for assuring clamping success was helpful in designing an SRAC program and thus benefiting the LPN procedure.

     

腹主动脉阻断合并脓毒症大鼠脊髓损伤的实验研究

目的 观察大鼠腹主动脉阻断术(AAC)后合并脓毒症时脊髓病理改变及肿瘤坏死因子(TNF)-α的表达.方法 Wistar大鼠32只,随机均分为四组:假手术组(A组),AAC组(B组),LPS组(C组),AAC+ LPS组(D组).所有动物均于再灌注后8h处死,处死前进行后肢神经功能评分,取脊髓行HE染色观察脊髓组织病理损害和免疫组化检测脊髓前角TNF-α的表达.结果 HE染色显示A组损伤较轻;B组可见炎性反应明显,较多神经元坏死;C组有炎性表现,较少神经元坏死,较多运动神经元凋亡;D组可见强烈炎性表现,大量神经元坏死.A组TNF-α少量表达,显著低于其它三组(P＜0.01).C组TNF-α显著高于其它三组(P＜0.01).A、C组后肢神经功能评分显著高于B、D组(P＜0.05或P＜0.01).结论 TNF-α在AAC后脓毒症急性脊髓损伤中发挥了重要作用,介导了运动神经元的坏死或凋亡.AAC后机体可存在免疫紊乱,如此时发生脓毒症,TNF-α表达增加可能不如单纯脓毒症明显.