摘要
目的探讨早期急性肠系膜上动脉血栓栓塞症(ASMAT)患者采用AngioJet或Rotarex机械血栓清除装置治疗的效果及安全性。方法2015年7月-2022年7月上海交通大学医学院附属第九人民医院、新乡市中心医院、首都医科大学附属北京友谊医院、郑州大学第一附属医院、河南省人民医院诊治ASMAT患者55例,采用AngioJe机械血栓清除装置治疗者31例为AngioJet组,采用Rotarex机械血栓清除装置治疗者24例为Rotarex组,比较2组术中尿激酶用量、抽吸时间、失血量、管腔残余狭窄率、术中并发症(血管破裂/夹层、血管远端栓塞)发生率及术后血尿发生率、技术成功率、临床成功率、围手术期病死率等。术后随访6~36个月,比较2组血栓复发率、管腔再狭窄率等。结果Rotarex组术中尿激酶用量(0 u)、失血量[(40.5±17.5)mL]、抽吸时间[(54.5±17.5)s]均少于AngioJet组[(20.0±10.5)万u、(83.5±26.5)mL、(87.5±20.5)s](P<0.05),术中血管破裂/夹层发生率(12.50%)高于AngioJet组(3.23%)(χ^(2)=-2.980,P=0.048),血管远端栓塞发生率(16.67%)低于AngioJet组(29.03%)(χ^(2)=3.123,P=0.046),管腔残余狭窄率与AngioJet组比较差异无统计学意义(P>0.05)。Rotarex组术后血尿发生率(0)低于AngioJet组(29.03%)(χ^(2)=7.763,P<0.001),技术成功率、临床成功率、围手术期病死率(100.00%、100.00%、4.17%)与AngioJet组(100.00%、96.77%、0)比较差异均无统计学意义(P>0.05)。术后随访(19.5±16.5)个月,Rotarex组血栓复发率、管腔再狭窄率(0、0)与AngioJet组(0、3.22%)比较差异均无统计学意义(χ^(2)<0.001,P>0.999;χ^(2)=0.867,P=0.336)。结论ASMAT患者采用AngioJet或Rotarex机械血栓清除装置治疗血栓清除均满意,安全性好;AngioJet需注意术中血管远端栓塞发生风险,Rotarex需注意术中血管破裂/夹层发生风险。
Objective To investigate the efficacy and safety of AngioJet and Rota rex thrombectomy devices in the treatment of early acute superior mesenteric artery embolism.Methods Fifty-five patients with early acute superior mesenteric artery embolism were diagnosed and treated in the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Xinxiang Central Hospital,Beijing Friendship Hospital,the First Affiliated Hospital of Zhengzhou University and Henan Provincial People's Hospital,among whom 31 were treated with AngioJet thrombus clearance device(AngioJet group)and 24 were treated with Rotarex thrombus clearance device(Rotarex group).The intraoperative urokinase dosage,thrombus aspiration time,blood loss,residual stenosis rate and incidence of complications(vascular rupture/dissection and distal vascular embolism),the postoperative incidence of hematuria,the technical success rate,the clinical success rate,and the perioperative mortality rate were compared between two groups.A follow-up was conducted for 6 to 36 months postoperatively,and the recurrence rate of thrombosis and restenosis rate were compared between two groups.Results The amount of urokinase used,blood loss and thrombus aspiration time were lower in Rotarex group[0 u,(40.5±17.5)mL,(54.5±17.5)s]than those in AngioJet group[(200000±105000)u,(83.5±26.5)mL,(87.5±20.5)s](P<0.05).The incidence of intraoperative vascular rupture/dissection was higher in Rotarex group(12.50%)than that in AngioJet group(3.23%)(χ^(2)=-2.980,P=0.048),the incidence of distal vascular embolism was lower in Rotarex group(16.67%)than that in AngioJet group(29.03%)(χ^(2)=3.123,P=0.046),and there was no significant difference in the residual stenosis rate between two groups(P>0.05).The incidence of hematuria was lower in Rotarex group(0)than that in AngioJet group(29.03%)(χ^(2)=7.763,P<0.001).There were no significant differences in the technical success rate,clinical success rate,and perioperative mortality rate between Rotarex group(100.00%,100.00%,4.17%)and AngioJet group(100.00%,96.77%,0)(P>0.05).The follow-up survery lasted for(19.5±16.5)months,showing no significant differences in the recurrence rate of thrombosis and restenosis rate between Rotarex group(0,0)and AngioJet group(0,3.22%)(χ^(2)<0.001,P>0.999;χ^(2)=0.867.P=0.336).Conclusions Both AngioJet and Rotarex mechanical thrombectomy devices can achieve satisfied results for early acute superior mesenteric artery embolism,with a high safety.The distal vascular embolism and vascular rupture/dissection should be prevented during surgery with AngioJet and Rotarex thrombectomy devices,respectively.
作者
王国华
张华
崔明哲
化召辉
张喆
陆信武
WANG Guohua;ZHANG Hua;CUI Mingzhe;HUA Zhaohui;ZHANG Zhe;LU Xinwu(Department of Vascular Surgery,Xinxiang Central Hospital,Xinciang,Henan 453000,China;Department of Vascular Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Vascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Vascular Surgery,the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)
出处
《中华实用诊断与治疗杂志》
2023年第8期827-831,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划联合共建项目(LHGJ20220990)。
