天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (10): 1044-1048.doi: 10.11958/20170783

• 临床研究 • 上一篇    下一篇

DSA 联合双腔 Fogarty 导管在静脉危象中应用的临床研究

李小东 1，王培 1△，谷锐 2，林静 2，严晓薇 3   

  1. 1 承德医学院附属医院手足外科（邮编 067000），2 创伤骨科，3 重症医学科
  • 收稿日期:2017-07-03 修回日期:2017-08-02 出版日期:2017-10-15 发布日期:2017-10-13
  • 通讯作者: 李小东 E-mail:15097824763@163.com
  • 作者简介:李小东（1983），男，主治医师，硕士，主要从事显微外科及血管损伤诊疗方面研究
  • 基金资助:
    2016年度河北省卫生厅指令性项目

Clinical study of DSA combined with dual - chamber Fogarty catheter in venous crisis

LI Xiao-dong1, WANG Pei1△, GU Rui2, LIN Jing2, YAN Xiao-wei3   

  1. 1 Department of Hand and Foot Surgery, 2 Department of Trauma Orthopedics, 3 Department of Critical Care Medicine, the Affiliated Hospital of Chengde Medical College, Chengde 067000，China
  • Received:2017-07-03 Revised:2017-08-02 Published:2017-10-15 Online:2017-10-13
  • Contact: Xiao-Dong LI E-mail:15097824763@163.com

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摘要： 目的 观察数字减影血管造影（DSA）联合双腔 Fogarty 导管在断肢再植术后静脉危象中应用的临床疗 效。方法 2011 年 6 月—2016 年 1 月采用 DSA 联合双腔 Fogarty 导管处理断肢再植术后发生静脉危象的患者 12 例。结果 术后 11 例成活，切口均Ⅰ期愈合，其中 1 例出现骨筋膜室综合征，行手术切开治疗，恢复良好；1 例出现 急性肝功能损害，予以内科综合治疗，急性肝功能损害纠正。术后 1 例再次出现静脉危象，行切开探查手术，再次出 现静脉血栓，肢体部分坏死，行截肢术，切口Ⅰ期愈合。所有患者未发生血管破裂、空气栓塞、感染及脓毒血症等并 发症。血栓均存在于静脉血管内，长度为 0.6～4.2 cm。排除切开探查术的 1 例患者，采用 Fogarty 导管处理的 11 例 患者，平均随访 11 个月（7~29 个月），患肢外形满意，肢体血运改善，毛细血管充盈时间 1.5～3.3 s，肿胀度改善明显， 皮温正常或较患肢低 0.6～1.5 ℃，皮肤颜色正常，活动度改善，感觉恢复 S0～S4级，平均位于 S3+级，两点辨别觉 3～8 mm，平均 4.5 mm。参照中华医学会手外科学分会断肢再植功能评定试用标准评价疗效，本组优 5 例，良 4 例，差 2 例。结论 应用 DSA 联合双腔 Fogarty 球囊导管处理静脉危象，血栓定位精确，静脉分支血管的针对性提高，微创、 快捷，临床效果满意。

关键词: 再植术, 血管造影术, 数字减影, 断肢再植, 静脉危象, Fogarty 导管

Abstract: Objective To observe the clinical effect of digital subtraction angiography (DSA) combined with doublechamber Fogarty catheter in venous crisis after replantation of severed extremities. Methods A total of 12 cases with venous crisis after replantation of severed extremities treated by DSA combined with double-chamber Fogarty catheter from June 2011 to January 2016 were included in this study. Results Eleven cases survived after operation. Healing status of surgical incisions was stage Ⅰ for all patients. Of which osteofascial compartment syndrome was found in 1 case, and it was cured by surgical incision treatment; liver damage was found in another case, and acute liver damage was treated by comprehensive treatment of internal medicine. The postoperative venous thrombosis was found again in one case. The patient underwent exploratory surgery, and venous thrombosis was found again, limb partial necrosis was found, amputation was perform, and the incision was healed in Ⅰ stage. Complications including vascular rupture, air embolism, infection and sepsis were not found in all patients. Thrombosis was presented in the vein, the length of 0.6-4.2 cm. A total of 11 patients were treated with Fogarty catheters and followed up for 11 months (7 months to 29 months). The limb shape of the patient was satisfactory, blood supply of limb was improved, and capillary filling time was 1.5-3.3 s, swelling degree was improved, skin temperature was normal or lower than the limb 0.6-1.5 ℃, the skin color was normal, the activity improved, the feeling of recovery S0- S4 levels, the average in the S3 + level, two- point discrimination was 3- 8 mm with an average of 4.5 mm. According to the evaluation criteria of the replantation function of the limb replantation of the Chinese Medical Association, 5 cases were excellent, 4 cases were good and 2 cases were poor. Conclusion The application of DSA combined with double- chamber Fogarty balloon catheter for the treatment of venous crisis shows precise localization of thrombosis, increased targeting venous branch in blood vessels, minimally invasion, quick, and satisfactory clinical results.

Key words: replantation, angiography, digital subtraction, replantation of limb, venous crisis, Fogarty catheter