杂交手术在急性下肢动脉缺血救治中的应用

目的:探讨杂交手术治疗下肢急性缺血(ALI)的临床疗效。方法:回顾性分析2011年3月—2014年4月行开放手术联合腔内技术治疗的43例患者46条ALI肢体临床资料。结果:手术技术成功率为97.7%(42/43),血栓残留率为7.0%(3/43),术后平均踝肱指数为0.85±0.48。9例(20.9%)因骨筋膜室综合征进行了切开减压术,围手术期截肢3例(7.0%),截趾1例(2.3%),死亡3例(7.0%)。1例术后3个月因脑卒中死亡,35例完成了至少12个月的随访,期间2例股腘动脉支架植入患者出现了再狭窄。结论:杂交手术治疗ALI技术成功率高,血栓残留率低,可以一期取出血栓和治疗血管病变,具有临床应用价值。

Application of hybrid procedures in treatment of acute limb ischemia

Objective: To investigate the clinical efficacy of hybrid procedures in treatment of acute limb ischemia (ALI). Methods: The clinical data of 43 patients with 46 ALI limbs undergoing combination treatment of conventional surgery and endovascular techniques between March 2011 and April 2014 were retrospectively analyzed.Results: The technical success rate was 97.7% (42/43), residual thrombosis rate was 7.0% (3/43), and the average ankle-brachial index after operation was 0.85±0.48. Nine patients (20.9%) developed osteofascial compartment syndrome and underwent open decompression, and during perioperative period, 3 patients (7.0%) underwent extremity amputation, one patient (2.3%) had toe amputation, and 3 patients (7.0%) died. One patient died of cerebral infarction 3 months after operation, and 35 patients were followed-up for more than 12 months, during which time, restenosis occurred in 2 cases who had popliteal artery stent placement.Conclusion: In the treatment of ALI, hybrid surgery shows high technical success rate and low residual thrombosis rate, thrombus removal and vascular reconstruction can be simultaneously conducted, and is worthy of clinical application.