本文選題：彩色多普勒超聲 + Fogarty球囊導(dǎo)管　； 參考：《中國修復(fù)重建外科雜志》2017年10期

【摘要】：目的觀察超聲引導(dǎo)下Fogarty球囊導(dǎo)管在斷肢再植術(shù)后動脈危象中應(yīng)用的臨床療效。方法 2012年1月—2016年7月,應(yīng)用超聲引導(dǎo)下Fogarty球囊導(dǎo)管聯(lián)合溶栓抗凝藥物治療斷肢再植術(shù)后動脈危象患者27例。男18例,女9例;年齡19~51歲,平均32歲。膝關(guān)節(jié)離斷3例,小腿離斷9例,踝關(guān)節(jié)離斷6例,肘關(guān)節(jié)離斷2例,前臂離斷4例,腕關(guān)節(jié)離斷3例。于斷肢再植術(shù)后2.5~18 h,平均7.5 h出現(xiàn)動脈危象。均采用彩色多普勒超聲檢查明確診斷,其中吻合口血栓16例,非吻合口血栓7例,聯(lián)合血栓4例。血栓均存在于動脈內(nèi),長度為0.8~3.9 cm。結(jié)果術(shù)后患者均未發(fā)生血管穿孔、破裂、空氣栓塞、血栓栓塞、傷口感染及敗血癥等并發(fā)癥。術(shù)后1.5~13.5 h 3例再次出現(xiàn)動脈危象,行切開探查術(shù),1例治療成功;2例動脈閉塞,肢體部分壞死,行截肢術(shù)。余24例患肢順利成活,切口均Ⅰ期愈合,其中1例出現(xiàn)急性肌病腎病代謝綜合征,予以血液透析后得以糾正;1例出現(xiàn)急性肝功能損害,予以內(nèi)科綜合治療糾正。24例患者獲隨訪7~38個月,平均11個月。末次隨訪時肢體血運(yùn)良好,皮溫正常,感覺、活動度及腫脹度均改善。參照中華醫(yī)學(xué)會手外科學(xué)會上肢部分功能評定試用標(biāo)準(zhǔn)評價療效,獲優(yōu)12例、良8例、差4例,優(yōu)良率83.3%。結(jié)論超聲引導(dǎo)下應(yīng)用Fogarty球囊導(dǎo)管處理斷肢再植術(shù)后動脈危象,血栓定位精準(zhǔn),取栓快捷、微創(chuàng),避免了盲目、反復(fù)取栓,臨床療效肯定。
[Abstract]:Objective to observe the clinical effect of Fogarty balloon catheter guided by ultrasound in patients with arterial crisis after replantation of severed limbs. Methods from January 2012 to July 2016, 27 patients with arterial crisis after replantation were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic and anticoagulant drugs. There were 18 males and 9 females, aged 19 to 51 years (mean 32 years). The knee joint was broken in 3 cases, the leg in 9 cases, the ankle joint in 6 cases, the elbow joint in 2 cases, the forearm in 4 cases and the wrist joint in 3 cases. After replantation of amputated limbs, arterial crisis appeared at 2.5 h and 18 h on average at 7.5 h. All cases were diagnosed by color Doppler ultrasound, including 16 cases of anastomotic thrombus, 7 cases of non-anastomotic thrombus and 4 cases of combined thrombus. Thrombosis was found in the arteries with a length of 0.810 cm. Results there were no complications such as perforation, rupture, air embolism, thromboembolism, wound infection and septicemia. Arterial crisis occurred again in 3 cases at 1.5h to 13.5 h after operation. One case was successfully treated with open exploration and 2 cases with arterial occlusion, partial necrosis of limbs, and amputation. The remaining 24 patients survived successfully and all the incisions healed in the first stage. Among them, one patient developed acute myopathy nephrotic metabolic syndrome, one patient was corrected after hemodialysis, and 1 patient had acute liver function damage. 24 patients were followed up for 7 ~ 38 months (mean 11 months). At the last follow-up, the limb blood flow was good, the skin temperature was normal, and the sensation, activity and swelling were improved. According to the evaluation criteria of upper limb function of the Chinese Medical Association, 12 cases were excellent, 8 good and 4 poor, and the excellent and good rate was 83.3%. Conclusion under the guidance of ultrasound, Fogarty balloon catheter is used to treat the arterial crisis after replantation of severed limbs. The location of thrombus is accurate, the thrombus removal is quick and minimally invasive, the blind and repeated embolization is avoided, and the clinical curative effect is positive.
【作者單位】： 承德醫(yī)學(xué)院附屬醫(yī)院手足外科;承德醫(yī)學(xué)院附屬醫(yī)院重癥醫(yī)學(xué)科;承德醫(yī)學(xué)院附屬醫(yī)院血管外科;
【基金】：2016年度河北省衛(wèi)生廳指令性項目(20160010)~~
【分類號】：R658.1

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