中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2015年
6期
440-443
,共4页
倪冷%李拥军%郑月宏%刘暴%曾嵘%叶炜%刘昌伟
倪冷%李擁軍%鄭月宏%劉暴%曾嶸%葉煒%劉昌偉
예랭%리옹군%정월굉%류폭%증영%협위%류창위
动脉闭塞性疾病%手术后并发症%血管成形术%支架%主髂动脉
動脈閉塞性疾病%手術後併髮癥%血管成形術%支架%主髂動脈
동맥폐새성질병%수술후병발증%혈관성형술%지가%주가동맥
Arterial occlusive disease%Postoperative complications%Angioplasty%Stents%Aortoiliac artery
目的 探讨主髂动脉闭塞性病变腔内治疗相关并发症的防治策略.方法 2012年6月至2014年6月中国医学科学院北京协和医学院北京协和医院行腔内治疗的主髂动脉病变患者共220例(283条肢体),男189例,女31例;年龄46 ~ 85岁,平均(64±10)岁.回顾性分析介入相关并发症的发生情况及处理方法.结果 介入成功率为97.2%.7例患者共发生9例次并发症,发生率为4.1%.其中急性支架内血栓2例次(0.9%)、髂动脉破裂1例(0.45%)、远端动脉栓塞1例(0.45%)、穿刺相关并发症5例次(2.3%)(急性肱动脉血栓2例次,动静脉瘘1例,穿刺点血肿1例,穿刺动脉夹层1例).8例经腔内或手术补救治疗后好转,其中4例行腔内治疗(支架内置管溶栓2例、补救性覆膜支架植入术1例、球囊扩张术1例),4例行开放手术(动脉切开取栓3例、血肿清除术1例);另1例肱动静脉瘘患者因症状较轻未行手术治疗.术后平均随访时间为(22±17)个月,一期通畅率、辅助一期通畅率及二期通畅率分别为90.8%、92.1%及99.2%.结论 根据术前对病变的充分评估制定个体化手术方案、术中规范及轻柔操作是预防主髂动脉腔内治疗相关并发症的关键.
目的 探討主髂動脈閉塞性病變腔內治療相關併髮癥的防治策略.方法 2012年6月至2014年6月中國醫學科學院北京協和醫學院北京協和醫院行腔內治療的主髂動脈病變患者共220例(283條肢體),男189例,女31例;年齡46 ~ 85歲,平均(64±10)歲.迴顧性分析介入相關併髮癥的髮生情況及處理方法.結果 介入成功率為97.2%.7例患者共髮生9例次併髮癥,髮生率為4.1%.其中急性支架內血栓2例次(0.9%)、髂動脈破裂1例(0.45%)、遠耑動脈栓塞1例(0.45%)、穿刺相關併髮癥5例次(2.3%)(急性肱動脈血栓2例次,動靜脈瘺1例,穿刺點血腫1例,穿刺動脈夾層1例).8例經腔內或手術補救治療後好轉,其中4例行腔內治療(支架內置管溶栓2例、補救性覆膜支架植入術1例、毬囊擴張術1例),4例行開放手術(動脈切開取栓3例、血腫清除術1例);另1例肱動靜脈瘺患者因癥狀較輕未行手術治療.術後平均隨訪時間為(22±17)箇月,一期通暢率、輔助一期通暢率及二期通暢率分彆為90.8%、92.1%及99.2%.結論 根據術前對病變的充分評估製定箇體化手術方案、術中規範及輕柔操作是預防主髂動脈腔內治療相關併髮癥的關鍵.
목적 탐토주가동맥폐새성병변강내치료상관병발증적방치책략.방법 2012년6월지2014년6월중국의학과학원북경협화의학원북경협화의원행강내치료적주가동맥병변환자공220례(283조지체),남189례,녀31례;년령46 ~ 85세,평균(64±10)세.회고성분석개입상관병발증적발생정황급처리방법.결과 개입성공솔위97.2%.7례환자공발생9례차병발증,발생솔위4.1%.기중급성지가내혈전2례차(0.9%)、가동맥파렬1례(0.45%)、원단동맥전새1례(0.45%)、천자상관병발증5례차(2.3%)(급성굉동맥혈전2례차,동정맥루1례,천자점혈종1례,천자동맥협층1례).8례경강내혹수술보구치료후호전,기중4례행강내치료(지가내치관용전2례、보구성복막지가식입술1례、구낭확장술1례),4례행개방수술(동맥절개취전3례、혈종청제술1례);령1례굉동정맥루환자인증상교경미행수술치료.술후평균수방시간위(22±17)개월,일기통창솔、보조일기통창솔급이기통창솔분별위90.8%、92.1%급99.2%.결론 근거술전대병변적충분평고제정개체화수술방안、술중규범급경유조작시예방주가동맥강내치료상관병발증적관건.
Objective To discuss the strategies of prevention and treatment for complications of endovascular therapy in aortoiliac artery occlusive disease.Methods 220 cases who received endovascular interventions with aortoiliac artery occlusive disease were retrospectively reviewed from June 2012 to June 2014.Among these patients,189 cases were males.The age was between 46 to 85yrs and the average age was 64yrs.Results The overall technique success rate was 97.2%.Nine procedure-related major complications requiring additional endovascular or surgical treatment were encountered in 7 patients including 2 acute in-stent thrombosis,1 iliac artery rupture,1 distal embolism,and 5 puncture associated complications (2 acute artery thrombosis,1 arteriovenous fistula,1 hematoma,1 artery dissection).8 cases improved after second endovascular or remedial open surgery,among those 4 cases were managed by endovascular interventions including 2 catheter directed thrombolysis,1 cover-stent implantation and 1 balloon-based angioplasty,4 patients received open surgery including 3 thrombectomies,1 hematoma cleating.After 22 months follow-up,the primary patency,assistant-primary patency and secondary patency was respectively 90.8%,92.1% and 99.2%.Conclusions More attentions should be paid to the complications of endovascular therapy in aortoiliac artery occlusive disease.Helpful to prevent these complications are a comprehensive evaluation of the lesions,and individualized surgical plan prior to the operations,and a careful intraoperative management.