von Knorring S, Peräkylä T, Edgren J, Saarinen O, Tierala E, Mätzke S, Lepäntalo M
Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Ann Chir Gynaecol. 1995;84(4):369-71.
The efficacy of thrombolysis was retrospectively studied in patients with acute on chronic ischaemia in the lower extremity. A total number of 68 thrombolytic treatments were given to 65 patients, 58 (85%) because of native arterial occlusions and 10 (15%) because of occluded grafts. Tissue plasminogen activator was the lytic agent used in all patients. In native arteries, thrombolysis alone was successful in 15 (52%) out of 29 legs, whereas 22 (85%) out of 26 thrombolyses followed by angioplasty or surgery were effective. Thrombolysis alone was successful in two and failed in five out of 10 occluded grafts. Patency was achieved by combination with surgery in the other three cases. Twelve-month patency was 34% after thrombolysis alone and 69% (P < 0.05) when combined with surgery or angioplasty. The 30-day mortality rate was 9%. Thrombolysis can be used alone in acute on chronic ischaemia in the lower extremities. The immediate and the long-term results are clearly improved when thrombolysis is combined with angioplasty or reconstructive surgery to treat the underlying cause.
我们对下肢慢性缺血急性发作患者的溶栓疗效进行了回顾性研究。共对65例患者进行了68次溶栓治疗，其中58例（85%）是因为原发性动脉闭塞，10例（15%）是因为移植血管闭塞。所有患者均使用组织型纤溶酶原激活剂作为溶栓药物。在原发性动脉中，29条腿中有15条（52%）单纯溶栓成功，而26次溶栓后进行血管成形术或手术的患者中，有22例（85%）有效。10例移植血管闭塞患者中，单纯溶栓2例成功，5例失败。另外3例通过联合手术实现了血管通畅。单纯溶栓后12个月的通畅率为34%，联合手术或血管成形术时为69%（P<0.05）。30天死亡率为9%。下肢慢性缺血急性发作时可单独使用溶栓治疗。当溶栓联合血管成形术或重建手术以治疗潜在病因时，近期和远期效果均有明显改善。
