本文選題：雜交手術　切入點：腹主動脈阻斷術　出處：《山東醫(yī)藥》2017年18期 　論文類型：期刊論文

【摘要】：目的總結(jié)雜交手術治療腹主動脈阻斷后繼發(fā)動脈血栓形成的經(jīng)驗教訓。方法回顧性分析腹主動脈阻斷后繼發(fā)右髂動脈血栓形成雜交手術后再次繼發(fā)股淺動脈血栓1例患者的臨床資料。結(jié)果患者女,40歲,因右下肢發(fā)涼、怕冷,麻木伴間歇性跛行3月余就診�；颊咴�35周時因前置胎盤出現(xiàn)陰道流血,遂在全身麻醉下行經(jīng)右股動脈行腹主動脈球囊阻斷術、雙側(cè)子宮動脈結(jié)扎術、雙側(cè)輸卵管結(jié)扎術、子宮體部剖宮產(chǎn)術、盆腔粘連松解術、子宮成形術,手術持續(xù)時間約8 h。術后第2天突感右下肢發(fā)涼怕冷,行動脈彩超示右髂動脈血栓形成,給予阿司匹林100 mg口服治療2周后無好轉(zhuǎn)。入院后完善術前檢查,排除手術禁忌證在基礎+局部浸潤麻醉下,行右下肢動脈球囊導管取栓術及球囊擴張,并行支架置入術。術后患者臨床癥狀緩解,脛后、足背動脈搏動良好。但患者術后3 h右股淺動脈手術切口及以遠突發(fā)動脈血栓形成,給予鎮(zhèn)痛、抗凝及抗血小板治療,疼痛癥狀緩解,但間歇性跛行癥狀持續(xù)存在。為防止手術縫線撕裂管壁滲漏,隨訪半年后再次將患者收入院,于股淺動脈閉塞段放置覆膜支架1枚,患者右下肢發(fā)涼、怕冷、麻木癥狀緩解,間歇性跛行癥狀消失。結(jié)論術前應綜合評估患者的狀況,嚴格把握動脈雜交手術的手術指征。
[Abstract]:Objective to summarize the experience and lessons of hybrid surgery in the treatment of secondary arterial thrombosis after abdominal aorta occlusion. Methods the secondary right iliac artery thrombosis after abdominal aorta occlusion was analyzed retrospectively. Clinical data of 1 patient. Results the patient was 40 years old. The patient had vaginal bleeding due to placenta previa at 35 weeks of pregnancy, and was subjected to abdominal aortic balloon occlusion via right femoral artery and bilateral uterine artery ligation under general anesthesia. Bilateral tubal ligation, cesarean section of uterus, release of pelvic adhesions, hysteroplasty, and operation lasted about 8 hours. There was no improvement after oral administration of aspirin 100mg for 2 weeks. The preoperative examination was improved after admission, and the right lower extremity artery balloon catheter thrombectomy and balloon dilatation were performed under basic local infiltration anesthesia. The patients were treated with stent implantation. The clinical symptoms were relieved and the pulsation of the dorsal foot artery was good after tibia. However, the patients were treated with analgesic, anticoagulant and antiplatelet therapy through the right superficial femoral artery incision 3 hours after the operation and the distal burst of arterial thrombosis, and the patients received analgesic, anticoagulant and antiplatelet therapy. The pain symptoms were relieved, but intermittent claudication symptoms persisted. In order to prevent the seams from leaking, the patients were admitted to the hospital again after half a year's follow-up, and a covered stent was placed in the occluded segment of the superficial femoral artery. The patient's right lower extremities were cool and afraid of cold. The symptoms of numbness were alleviated and the intermittent claudication symptoms disappeared. Conclusion the preoperative condition of the patients should be comprehensively evaluated and the operative indications of arterial hybrid surgery should be strictly grasped.
【作者單位】： 山東中醫(yī)藥大學;山東中醫(yī)藥大學附屬醫(yī)院;
【分類號】：R654.3

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