摘要
目的探讨上肢动脉缺血的病因、血运重建方法及相关并发症的临床处理。方法2003年3月-2008年2月,收治72例上肢动脉缺血患者。男44例,女28例;年龄19～90岁,中位年龄63岁。病程1h～2年。患者均有上肢发凉、麻木、疼痛等缺血表现。综合分析病因、病情,分别予取栓、动脉瘤切除血管重建、球囊扩张支架植入、内膜剥脱、补片成形、自体静脉转流或移植、动静脉瘘缩窄或结扎等处理重建血运。结果60例(83.3%)术后血运恢复良好;6例(8.3%)出现再栓塞;4例(5.6%)缺血时间较长出现肢体功能障碍肌肉挛缩;2例(2.8%)出现骨筋膜室综合征。共截肢2例(2.8%)。1例于术后3d因过度抗凝治疗死于脑溢血(1.4%)。术后患者均获随访,随访时间1～6年,平均52个月。4例患者复发,接受再次治疗后好转;余患者情况良好:皮温及肤色正常,桡、尺动脉均可触及,指端血氧饱和度均>90%,彩色超声多普勒示上肢动脉血流通畅。结论术前明确上肢动脉缺血病因,及早诊断并尽快予针对性血运重建术是治疗上肢动脉缺血的关键。
Objective To investigate the etiology, diagnosis, revascularization of upper limb ischemia and the complications. Methods From March 2003 to February 2008, 72 cases of upper limb ischemia were treated. There were 44 males and 28 females, aged 19-90 years old （median 63 years old）. The duration of the disease was 1 hour to 2 years. All cases had symptoms of limb ischemia such as paleness, coldness, paralysis. According to individual condition, 72 patients accepted revascularizations including thromboembolectomy, reconstruction after traumatic injuries, pseudoaneurysm excision and angioplasty, balloon dilatation and stent implant, arterial repair, patch, vascular prosthesis or vein bypass/transplantation, and ligation or coarctation of fistula. Results Sixty patients （83.3%） recovered well after operation. Re-occlusion following thromboemboletomy was found in 6 patients （8.3%）. And there were 4 patients （5.6%） with limbs disturbance and muscles contracture and 2 patients （2.8%） with compartment syndrome in this series. The affected limb had to be amputated in 2 patients （2.8%）. And 1 patient （1.4%） died of cerebral hemorrhage because of anticoagulation 3 days after operation. All patients were followed up 1-6 years （mean 52 months） after operation. Four patients recurred and got improved after retreatments. The others got a good result with normal skin color and temperature, restoration of the radial and ulnar pulses, normal saturation of blood oxygen of finger tip （〉 90%） and patent blood flow of affected arteries was shown by color Doppler ultrasound. Conclusion The study indicates that identifying the etiology of upper limb ischemia before operation and active revascularizations consistent with different causes are the key to treat the upper limb ischemia.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第9期1101-1103,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
上肢动脉缺血
病因
血运重建
并发症
Upper limb ischemia Etiology Revascularization Complications
