下肢动脉疾病专题研究(Monographic Study of Arterial Diseases of The Lower Extremities)

急性下肢缺血的治疗策略:附62 例报告

Published at: 2015年第24卷第12期

李振振 1 , 曾昭凡 1 , 肖占祥 1 , 戚悠飞 1 , 张文波 1 , 李灼日 1
1 海南省人民医院 血管外科,海南 海口 570311
通讯作者 占祥 肖 Email: xiaozhanxiang@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.12.011
基金:
海南省自然科学基金资助项目 814317

摘要

目的:探讨急性下肢缺血(ALI)的有效治疗方式。 方法:回顾性分析2011 年3 月—2014 年9 月收治的62 例ALI 患者的临床资料。病因包括急性动脉栓塞, 急性动脉血栓形成,炎性血管病变以及主动脉夹层,所有患者均有不同程度的ALI 表现。根据ALI 类 型或患者情况,分别行开放手术(取栓、内膜剥脱、补片成形、动脉转流),介入手术(置管溶栓、 球囊扩张、支架植入)、复合手术或单纯药物治疗。 结果:治疗成功48 例(77.4%),截肢13 例(21.0%),其中炎性血管病变患者截肢率高达77.8%, 死亡2 例患者(脑梗死、肾功能衰竭各1 例);另1 例因夹层致病的患者死于心衰。55 例患者随访 3~42 个月,期间33 例无明显症状,正常生活,20 例仍有不同程度间歇性跛行或麻木,长期服药控制, 2 例死于心脑血管意外。 结论:早诊断、早处理是ALI 治疗的关键,如何选取合适的治疗方式是取得最佳疗效的重要环节。


Treatment strategy for acute lower limb ischemia: a report of 62 cases

Abstract

Objective: To investigate the appropriate management for acute limb ischemia (ALI). Methods: The clinical data of 62 patients with ALI treated from March 2011 to September 2014 were analyzed retrospectively. The causes for ALI included acute arterial embolism or thrombosis, inflammatory vascular diseases, and aortic dissection, and all patients had varying degrees of ALI symptoms. According to the clinical categories of ALI and individual conditions, different treatments were performed respectively, which included open surgery (embolectomy, endarterectomy, patch angioplasty or arterial bypass), interventional operation (catheter-directed thromboysis, balloon dilatation or stenting), hybrid procedures or medication treatment alone. Results: Treatment success was achieved in 48 cases (77.4%); 13 cases (21.0%) were subjected to amputation , among which, the amputation rate of those with inflammatory vascular disease was 77.8%, and 3 cases died (due to acute cerebral infarction, acute renal failure and heart failure, respectively). Fifty-five patients were followed up for 3 to 42 months, during which time, 33 cases had no noticeable symptoms and lived a normal life, while 20 cases still suffered varying degrees of intermittent claudication and numbness that required long-term medication for control, and 2 cases died due to cardiac or cerebral vascular events. Conclusion: For ALI, early diagnosis and prompt treatment are critical, and appropriate selection of treatment modality should be the decisive step for obtaining the maximal efficacy.


comments powered by Disqus

全文

引用

引用本文: 振振 李, 昭凡 曾, 占祥 肖, 悠飞 戚, 文波 张, 灼日 李. 急性下肢缺血的治疗策略:附62 例报告[J]. 中国普通外科杂志, 2015, 24(12): 1691-1695.
Cite this article as: LI Zhenzhen, ZENG Zhaofan, XIAO Zhanxiang, QI Youfei, ZHANG Wenbo, LI Zhuori . Treatment strategy for acute lower limb ischemia: a report of 62 cases[J]. Chin J Gen Surg, 2015, 24(12): 1691-1695.