Baláz P, Rokosný S, Chlupác J, Janousek L, Adamec M
Cévní oddelení, Klinika transplantacní chirurgie, IKEM Praha.
Rozhl Chir. 2011 Jan;90(1):55-8.
Acute limb ischemia is serious situation, jeopardizing limb salvage, causing embolization or thrombosis of the native arteries or vascular graft. Immediate surgical revascularization with balloon thromboembolectomy is indicated in patient with acute ischemia stage IIB of the Rutherford classification. Unfortunately, operative thromboembolectomy is frequently incomplete, with persistent thrombus remaining in the majority of patients. Residual thrombus compromises the clinical outcome, leading to poor revascularization and an increased risk of tissue loss. On depending of amount of the residual thrombus after surgical thromboembolectomy, we can choose one of the three options of intraoperative thrombolysis. This article summarized indication and technical realisation of intraoperative thrombolysis and describe cause report of the first patient treated with this method in our country. The combined use of intraoperative thrombolytics following mechanical thromboembolectomy is safe and efficacious method in patients with acute vascular occlusion.
急性肢体缺血是一种严重情况，会危及肢体保全，导致自身动脉或血管移植物发生栓塞或血栓形成。对于Rutherford分级为急性缺血IIB期的患者，建议立即进行球囊取栓术实现手术再血管化。不幸的是，手术取栓术常常不彻底，大多数患者仍残留血栓。残留血栓会影响临床结局，导致再血管化不佳和组织丢失风险增加。根据手术取栓术后残留血栓的量，我们可以在术中溶栓的三种选择中挑选一种。本文总结了术中溶栓的适应证和技术实现方法，并描述了我国首例采用该方法治疗患者的病例报告。在急性血管闭塞患者中，机械取栓术后联合使用术中溶栓药物是一种安全有效的方法。
