下肢血栓闭塞性脉管炎的介入治疗体会

摘要

目的 探讨介入治疗下肢血栓闭塞性脉管炎(TAO)的可行性及疗效,总结治疗经验.方法 2006年10月至2011年10月,56例确诊下肢TAO患者入组.所有病例均行下肢CTA及动脉造影检查确诊及明确病变范围,联合采用“祛栓、导管溶栓、腔内成形、抗凝”方案进行治疗.结果 术后近期总有效率88.9％,治愈率32.1％,有效率60.8％,无效率7.1％.随访时间(37±12)个月,按照Cooley疗效标准,痊愈12例(21.5％)、良好30例(53.5％)、一般8例(14.3％)、差及截肢6例(10.7％).大部分患者患肢疼痛缓解,溃疡愈合,行走距离延长,踝肱指数(ABI)较术前明显提高.结论 介入治疗对下肢TAO是一种较为安全有效的方法；下肢缺血分期与介入治疗疗效具有显著的相关性,分期越高,疗效及预后越差；远端流出道对于介入治疗下肢TAO的疗效至关重要；积极开通闭塞血管对TAO治疗具有正向意义.%Objective To explore the feasibility and efficacy of interventional treatment for thromboangiitis obliterans (TAO), i.e. Buerger's disease, of lower extremities and to sum up preliminary clinical experience. Methods A total of 56 cases with confirmed TAO, who were encountered in authors' hospital during the period from October 2006 to October 2011, were enrolled in this study. CTA and angiography of the lower extremities were performed in all patients to clarify the diagnosis and the lesion's extent. Combination use of "thrombolytic therapy, catheter - directed thrombolysis, balloon dilatation/ endovascular stenting and anticoagulant therapy" was carried out in all patients. The results were analyzed. Results The total shor-term effective rate was 88.9%. The cure rate was 32.1%, the improvement rate was 60.8% and the valueless rate was 7.1%. All the patients were followed up for (37 ± 12) months. According to Cooley efficacy standard, complete cure was achieved in 12 cases(21.5%), good result in 30 cases (53.5%), general improvement in 8 cases (14.3%) and poor result or amputation in 6 cases (10.7%). After the treatment, pain relief, ulcer healing, elongated walking distance and significantly improved ankle-brachial index (ABI) were seen in most patients. Conclusion Interventional treatment is a relatively safe and effective method for TAO. The ischemia stage of lower limb carries significant correlation with the effect of interventional treatment, that is, the higher the ischemia stage is, the worse the efficacy of treatment and the prognosis would be. The arterial distal outflow has close relationship with the prognosis of TAO treated with interventional management. Therefore, it is of great importance to actively reopen the obstructed artery in the treatment of TAO.