中国血管外科杂志（电子版）
中國血管外科雜誌（電子版）
중국혈관외과잡지（전자판）
CHINESE JOURNAL OF VASCULAR SURGERY(ELECTRONIC VERSION)
2014年
3期
164-166,178
,共4页
赵堂海%郭明金%解远峰%战激光%张杰%逄晓军%秦少华
趙堂海%郭明金%解遠峰%戰激光%張傑%逄曉軍%秦少華
조당해%곽명금%해원봉%전격광%장걸%방효군%진소화
军事医学%急性肢体缺血%导管直接溶栓%急性血栓形成%外伤
軍事醫學%急性肢體缺血%導管直接溶栓%急性血栓形成%外傷
군사의학%급성지체결혈%도관직접용전%급성혈전형성%외상
Military medicine%Acute limb ischemia%Catheter-directed thrombolysis%Acute thrombosis%Trauma
目的：探讨应用导管接触性溶栓（CDT）治疗肢体军训伤后继发动脉血栓形成的临床效果。方法回顾性分析2005年3月至2013年3月收治的43例肢体军训伤后继发动脉血栓形成患者应用CDT治疗的临床资料。根据Rutherford分级：Ⅰ级1例，Ⅱa级23例，Ⅱb级15例，Ⅲ级4例。单纯应用CDT 22例，CDT+腔内球囊扩张成形（PTA）17例，CDT+PTA+支架植入4例。结果本组导管溶栓时间为1~7天，平均（3±2）天。治愈32例（74.4%），Ⅰ级1例，Ⅱa级21例，Ⅱb级9例，Ⅲ级1例；其中单纯CDT 22例，CDT+PTA 6例，CDT+PTA+支架植入4例。有效11例（25.6%），Ⅱa级2例，Ⅱb级6例，Ⅲ级3例；均施行CDT+PTA治疗。2例（4.7%）溶栓过程中发生二次栓塞予调整导管位置后继续溶栓，5例（11.6%）溶栓过程中发生小腿骨筋膜室综合征行骨筋膜室切开减压术，均保趾、保肢成功。43例均获得随访，随访时间12~108个月，平均（48±19）个月。患者均无症状加重或复发。结论 CDT治疗四肢外伤后继发动脉血栓形成是一种安全、有效、微创的方法。
目的：探討應用導管接觸性溶栓（CDT）治療肢體軍訓傷後繼髮動脈血栓形成的臨床效果。方法迴顧性分析2005年3月至2013年3月收治的43例肢體軍訓傷後繼髮動脈血栓形成患者應用CDT治療的臨床資料。根據Rutherford分級：Ⅰ級1例，Ⅱa級23例，Ⅱb級15例，Ⅲ級4例。單純應用CDT 22例，CDT+腔內毬囊擴張成形（PTA）17例，CDT+PTA+支架植入4例。結果本組導管溶栓時間為1~7天，平均（3±2）天。治愈32例（74.4%），Ⅰ級1例，Ⅱa級21例，Ⅱb級9例，Ⅲ級1例；其中單純CDT 22例，CDT+PTA 6例，CDT+PTA+支架植入4例。有效11例（25.6%），Ⅱa級2例，Ⅱb級6例，Ⅲ級3例；均施行CDT+PTA治療。2例（4.7%）溶栓過程中髮生二次栓塞予調整導管位置後繼續溶栓，5例（11.6%）溶栓過程中髮生小腿骨觔膜室綜閤徵行骨觔膜室切開減壓術，均保趾、保肢成功。43例均穫得隨訪，隨訪時間12~108箇月，平均（48±19）箇月。患者均無癥狀加重或複髮。結論 CDT治療四肢外傷後繼髮動脈血栓形成是一種安全、有效、微創的方法。
목적：탐토응용도관접촉성용전（CDT）치료지체군훈상후계발동맥혈전형성적림상효과。방법회고성분석2005년3월지2013년3월수치적43례지체군훈상후계발동맥혈전형성환자응용CDT치료적림상자료。근거Rutherford분급：Ⅰ급1례，Ⅱa급23례，Ⅱb급15례，Ⅲ급4례。단순응용CDT 22례，CDT+강내구낭확장성형（PTA）17례，CDT+PTA+지가식입4례。결과본조도관용전시간위1~7천，평균（3±2）천。치유32례（74.4%），Ⅰ급1례，Ⅱa급21례，Ⅱb급9례，Ⅲ급1례；기중단순CDT 22례，CDT+PTA 6례，CDT+PTA+지가식입4례。유효11례（25.6%），Ⅱa급2례，Ⅱb급6례，Ⅲ급3례；균시행CDT+PTA치료。2례（4.7%）용전과정중발생이차전새여조정도관위치후계속용전，5례（11.6%）용전과정중발생소퇴골근막실종합정행골근막실절개감압술，균보지、보지성공。43례균획득수방，수방시간12~108개월，평균（48±19）개월。환자균무증상가중혹복발。결론 CDT치료사지외상후계발동맥혈전형성시일충안전、유효、미창적방법。
Objective To evaluate the effect of catheter-directed thrombolysis(CDT)in the treatment of arterial thrombosis of extremities caused by military training injuries. Methods From Mar. 2005 to Mar. 2013,the clinical data of 43 patients(43 limbs)with arterial thrombosis of extremities caused by military training injuries treated by CDT were analyzed retrospectively. According to Rutherford Criteria , there were GradeⅠ1 cases,Grade Ⅱa 23 cases,Grade Ⅱb 15 cases,Grade Ⅲ4 cases. All of the cases underwent CDT with different procedures, including only CDT(22 cases), CDT combined with percutaneous transluminal angioplasty(PTA)(17 cases), CDT combined with PTA and stent implantation(4 cases). Results The CDT period was 1~7 days with a mean time of (3±2)days. Upon the results of angiography and following-up,32 cases(74.4%)were cured by only CDT(22 cases), CDT+PTA(6 cases)and CDT+PTA+stent implantation(4 cases), including GradeⅠ1 cases,GradeⅡa 21 cases,GradeⅡb 9 cases, GradeⅢ1 case. Eleven cases(25.6%)received effective results treated by CDT+PTA, including GradeⅡa 2 cases,GradeⅡb 6 cases,GradeⅢ3 cases. Secondary thrombosis occurred in 2 cases(4.7%)during the CDT, and thrombolysis continued after moving the catheter. Five cases(11.6%)underwent open decompression of compartment because of osteofascial compartment syndrome during the CDT and the extremities were saved. All cases(100.0%)were followed up with a mean time of (48±19) months(range,12~108 months), and no symptoms worsened and no recurrencde occurred. Conclusion CDT is a safe, effective and minimally invasive treatment for arterial thrombosis of extremities caused by military training injuries.
