标题：机械性取栓联合腔内成型术治疗急性下肢动脉栓塞疗效观察

      作者：叶贤德，龚溪明    上海浦东新区人民医院普外科，上海 200135

      卷次： 2021年32卷3期

      【摘要】 目的 探讨急性下肢动脉栓塞行机械性取栓(PMT)联合腔内成形术的治疗效果。方法 回顾性分析2016年1月至2018年6月因急性下肢动脉栓塞在上海浦东新区人民医院接受治疗的96例患者的临床资料，按治疗方法的不同分为观察组58例和对照组38例。观察组行机械性取栓联合腔内成型术，对照组行介入溶栓联合腔内成型术。比较两组患者的术后复通成功率、治疗相关指标、踝肱指数及术后并发症发生率。结果 观察组和对照组患者术后复通成功率(89.66% vs 73.68%)、术后3个月一期通畅率(87.93% vs 71.05%)比较，观察组明显高于对照组，术后3个月再狭窄率(12.07% vs 28.95%)、术后3个月二次干预率(12.07% vs 28.95%)、术后并发症发生率(3.44%vs 18.42%)比较，观察组明显低于对照组，差异均具有统计意义(P<0.05)；观察组和对照组患者术后6月截肢率分别为 3.45%和 5.26%，差异无统计学意义(P>0.05)；观察组和对照组患者术前踝肱指数分别为(0.21±0.04)和(0.22±0.03)，差异无统计学意义(P>0.05)；观察组患者术后24 h、1个月、3个月及6个月后的踝肱指数明显高于对照组，差异均具有统计学意义(P<0.05)。结论 PMT在急性下肢动脉栓塞的治疗中具有切口创伤小、成功率高等优点，疗效确切且安全性高，值得推广。
      【关键词】 急性下肢动脉栓塞；机械取栓；介入溶栓；腔内成型；疗效
      【中图分类号】 R543.5 【文献标识码】 A 【文章编号】 1003—6350（2021）03—0316—04

Curative effect of mechanical thrombectomy combined with intracavitary angioplasty in the treatment of acutelower extremity arterial embolism.
YE Xian-de, GONG Xi-ming. Department of General Surgery, Shanghai Pudong NewArea People's Hospital, Shanghai 200135, CHINA
【Abstract】 Objective To explore the therapeutic effect of percutaneous mechanical thrombectomy (PMT) com-bined with angioplasty in acute lower extremity arterial embolization. Methods The clinical data of 96 patients, whowere treated for acute lower extremity arterial embolism in Department of General Surgery, Shanghai Pudong New AreaPeople's Hospital from January 2016 to June 2018, were retrospectively analyzed. The patients were divided into the ex-perimental group (58 cases) and control group (38 cases). The experimental group underwent PMT combined with endo-vascular angioplasty, and the control group underwent interventional thrombolysis combined with endovascular angio-plasty. The success rate of postoperative recanalization, treatment-related indexes, ankle brachial index, and the inci-dence of postoperative complications were compared between the two groups. Results Three months after surgery, thesuccess rate of postoperative recanalization and the primary patency rate in the observation group were 89.66% and87.93%, which were significantly higher than corresponding 73.68% and 71.05% in the control group (P<0.05); the month-ly restenosis rate, second intervention rate, and postoperative complications rate of the observation group were 12.07%,12.07%, 3.44%, respectively, which were significantly lower than corresponding 28.95%, 28.95%, 18.42% of the controlgroup (all P<0.05). Six months after sugery, the amputation rates of patients in the observation group was 3.45% versus5.26% in the control group (P>0.05). The preoperative ankle-brachial index of the observation group was 0.21±0.04 versus0.22±0.03 in the control group (P>0.05). The ankle-brachial indexes of the observation group at 24 h, 1 month, 3 months,and 6 months after surgery were significantly higher than those of the control group (all P<0.05). Conclusion In the treat-ment of acute lower extremity arterial embolism, PMT has the advantages of small incision trauma, high success rate, etc.It has definite curative effect and high safety, and is worthy of promotion.
      【Key words】 Acute lower extremity arterial embolism; Percutaneous mechanical thrombectomy (PMT); Interven-tional thrombolysis; Angioplasty; Therapeutic effect