腹主动脉阻断后继发右髂动脉血栓形成杂交手术后再次继发股浅动脉血栓1例

发布时间：2018-03-04 15:18

本文选题：杂交手术　切入点：腹主动脉阻断术　出处：《山东医药》2017年18期 　论文类型：期刊论文

【摘要】：目的总结杂交手术治疗腹主动脉阻断后继发动脉血栓形成的经验教训。方法回顾性分析腹主动脉阻断后继发右髂动脉血栓形成杂交手术后再次继发股浅动脉血栓1例患者的临床资料。结果患者女,40岁,因右下肢发凉、怕冷,麻木伴间歇性跛行3月余就诊。患者孕35周时因前置胎盘出现阴道流血,遂在全身麻醉下行经右股动脉行腹主动脉球囊阻断术、双侧子宫动脉结扎术、双侧输卵管结扎术、子宫体部剖宫产术、盆腔粘连松解术、子宫成形术,手术持续时间约8 h。术后第2天突感右下肢发凉怕冷,行动脉彩超示右髂动脉血栓形成,给予阿司匹林100 mg口服治疗2周后无好转。入院后完善术前检查,排除手术禁忌证在基础+局部浸润麻醉下,行右下肢动脉球囊导管取栓术及球囊扩张,并行支架置入术。术后患者临床症状缓解,胫后、足背动脉搏动良好。但患者术后3 h右股浅动脉手术切口及以远突发动脉血栓形成,给予镇痛、抗凝及抗血小板治疗,疼痛症状缓解,但间歇性跛行症状持续存在。为防止手术缝线撕裂管壁渗漏,随访半年后再次将患者收入院,于股浅动脉闭塞段放置覆膜支架1枚,患者右下肢发凉、怕冷、麻木症状缓解,间歇性跛行症状消失。结论术前应综合评估患者的状况,严格把握动脉杂交手术的手术指征。
[Abstract]:Objective to summarize the experience and lessons of hybrid surgery in the treatment of secondary arterial thrombosis after abdominal aorta occlusion. Methods the secondary right iliac artery thrombosis after abdominal aorta occlusion was analyzed retrospectively. Clinical data of 1 patient. Results the patient was 40 years old. The patient had vaginal bleeding due to placenta previa at 35 weeks of pregnancy, and was subjected to abdominal aortic balloon occlusion via right femoral artery and bilateral uterine artery ligation under general anesthesia. Bilateral tubal ligation, cesarean section of uterus, release of pelvic adhesions, hysteroplasty, and operation lasted about 8 hours. There was no improvement after oral administration of aspirin 100mg for 2 weeks. The preoperative examination was improved after admission, and the right lower extremity artery balloon catheter thrombectomy and balloon dilatation were performed under basic local infiltration anesthesia. The patients were treated with stent implantation. The clinical symptoms were relieved and the pulsation of the dorsal foot artery was good after tibia. However, the patients were treated with analgesic, anticoagulant and antiplatelet therapy through the right superficial femoral artery incision 3 hours after the operation and the distal burst of arterial thrombosis, and the patients received analgesic, anticoagulant and antiplatelet therapy. The pain symptoms were relieved, but intermittent claudication symptoms persisted. In order to prevent the seams from leaking, the patients were admitted to the hospital again after half a year's follow-up, and a covered stent was placed in the occluded segment of the superficial femoral artery. The patient's right lower extremities were cool and afraid of cold. The symptoms of numbness were alleviated and the intermittent claudication symptoms disappeared. Conclusion the preoperative condition of the patients should be comprehensively evaluated and the operative indications of arterial hybrid surgery should be strictly grasped.
【作者单位】：山东中医药大学;山东中医药大学附属医院;
【分类号】：R654.3

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