急性肢体动脉缺血手术及非手术治疗效果比较.doc

急性肢体动脉缺血手术及非手术治疗效果比较 　 作者：杨永君 金星 吴学君 钟振岳 张十一 张精勇 董典宁 汪忠镐 【摘要】目的：分析急性肢体动脉缺血经手术切开取栓加置管溶栓和Seldinger技术下动脉穿刺单纯置管溶栓两种治疗方法疗效，探讨各自的适应证。方法：回顾性分析急性肢体动脉缺血41例，其中手术组26例利用动脉切开加Forgarty导管取栓和置管溶栓，非手术组15例利用Seldinger技术下动脉穿刺单纯置管溶栓，对两组的住院时间、痊愈率、截肢率进行分析。结果：手术治疗组和非手术治疗组截肢率和痊愈率分别为15.4%、84.6%和13.3%、86.6%，平均住院天数分别为27.6d和19d，差异均无统计学意义。结论：在手术治疗和单纯溶栓治疗保肢率和痊愈率相近的情况下，作好急性肢体缺血的术前鉴别诊断，进行个体化治疗，动脉栓塞选用手术治疗，动脉硬化性血栓形成选用非手术溶栓治疗，有望进一步降低截肢率和住院病死率。 【关键词】四肢#12539;缺血#12539;外科手术 Comparison of operative and nonoperative method for acute extremity ischemia 【ABSTRACT】Objective:A retrospective study was carried out to examine the efficacy of two treatment methods which waw operation+fogarty catheter embotectomy+setting a catheter thrombolysis versus only setting a catheter thrombolysis by Seldinger technic in treating the acute extremity ischemia.Methods:41 patients suffered from acute extremity ischemia studied in two group:operative group(transfermoral embolilctectomy+setting catheter thrombolysis) and nonoperative group (Seldinger technic therombotectomy+setting catheter thrombolysisi).Compare and analysis two groups ischemia severity,inpatient stay,health rate,amputation rate.Results:The statistic analysis results show that the age,gender,ischemia severity,inpatient stay,limb salvage rates and health rate all were no statistical difference bwtween wot group.The day of staty in hospital is 27.6 and 19 respectively,there are also no statistical difference.Conclusion:The differentiated diagnosis become more important as there are the same results between operative and nonoperative way in treating the acute extremity ischemia.The best way is chose the individual methods in treatment,operative way is suitable for embolism patients while nonoperative treatment is better used in thrombosis patients suitable elective treatment promised reducing the amputation rate and impatient mortality rate. 【KEY WORDS】Extremitics#12539;Ischemia#12539;Surgical procedures,operative 目前对于急性肢体动脉缺血的治疗选用手术动脉切开取栓治疗还是单纯动脉穿刺置管溶栓治疗，尚存在争