血栓闭塞性脉管炎介入治疗的临床研究

目的 探讨血栓闭塞性脉管炎介入治疗的可行性及有效性。方法 对13例血栓闭塞性脉管炎患者行左锁骨下动脉穿刺药盒植入术，将导管留置于患侧肢体髂外动脉，经导管药盒系统每日灌注前列腺素E1(PGE1)100μg，尿激酶(UK)20万U及脉络宁20ml。每一疗程为7～10d。结果 所有13例患者血管造影显示：1例于股浅动脉中段闭塞，9例腘动脉水平完全闭塞，3例胫前动脉完全闭塞，胫后动脉及腓动脉远端闭塞。经治疗后，其中3例已有坏疽者最终截肢，10例无坏疽者皮温升高，间歇性跛行及静息痛明显改善，行走距离均大于500m，Fontain分级至少提高2级。其中1例术后1年复查造影显示有大量侧支循环形成。结论 ①对于未出现坏疽的脉管炎患者，导管药盒系统的序贯治疗，能有效改善下肢缺血症状，降低截肢率。对于已有坏疽者，序贯治疗难以起到挽救肢体的作用；②通过导管药盒系统序贯治疗血栓闭塞性脉管炎是一种新的可行方法。

The clinical study of interventional therapy in thrombo angitis obliterans

Objective To evaluate the clinical feasibility and validity of interventional therapy in thrombo angitis obliterans. Methods 13 patients with thrombo angitis obliterans were treated with percutaneous left subclavian artery port catheter system implantation. The catheter external iliac artery with perfusion of prostaglandin E1 (PGE1) 100Ug, urokinase (UK) 200,000U and mailuoning 20 ml every day. Each treatment lasted for 7 10 days. Results 13 patients with angiographic demonstration showed occlusions of 1 case in the middle segment of superficial femoral artery, 9 cases of complete occlusion in popliteal artery and same for 3 cases in anterior tibial artery, the end of the peroneal artery and posterior tibial artery. After treatment, 3 patients had to undergo amputation due to gangrene in foot and 10 patients with no gangrene showed skin temperature rising up in the lower limb. Intermittent claudication and rest pain were relieved obviously accompanied by increasing step distance over 500 m with the Fontain grade improvement of twice at least. Follow up angiography one year later showed large quantity of vasculogenesis in the lower limb. Conclusion The treatment of trans port catheter system is excellent and practical for improving the clinical status of patients with thrombo angitis obliterans.