Rotarex机械性减容联合药涂球囊治疗动脉型胸廓出口综合征的疗效分析
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北京积水潭医院 血管外科,北京 100035

作者简介:

周密,北京积水潭医院主治医师,主要从事下肢深静脉血栓、下肢动脉硬化闭塞症诊治方面的研究。

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刘建龙,Email: liujlvip@126.com

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Efficacy analysis of Rotarex mechanical debulking combined with drug-coated balloon dilatation for arterial thoracic outlet syndrome
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Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing 100035, China

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    摘要:

    背景与目的 胸廓出口减压术,锁骨下动脉重建术被认为是治疗动脉型胸廓出口综合征(TOS)的标准术式,需要根据动脉受压的位置选择不同的手术入路,手术疗效确切,通常情况下术后患肢的长期功能预后满意。然而上述手术难度大,术者学习曲线长,手术创伤大,出血及神经损伤等并发症多,患者术后恢复慢。近年来,腔内技术的进步和血管耗材的创新使得相当一部分血管狭窄性病变可以通过介入手术的方式进行有效治疗,腔内治疗具有创伤小、并发症少、患者恢复快、可反复操作的优点。既往应用血管腔内技术治疗动脉型TOS的报道极少,因此,本研究探讨Rotarex机械性减容联合药涂球囊治疗动脉型TOS的初期临床疗效,以期为动脉型TOS提供新的可靠的治疗途径。方法 回顾性分析北京积水潭医院自2019年1月—2021年12月期间采用Rotarex机械性减容联合药涂球囊治疗的6例动脉型TOS患者的临床资料,统计手术成功率、手术时间、住院时间、术中出血量、手术并发症以及术后3个月的动脉通畅率、靶血管再干预率,比较术前与术后颈-臂症状评分、McGill疼痛评分,桡动脉搏动情况。结果 6例患者,手术成功率为100%,平均手术时间为(52.3±18.7)min,平均住院时间为(5.7±1.6)d,术中平均出血量(31.5±20.7)mL,无手术相关并发症,术后3个月的动脉通畅率为100%,术后3个月的靶血管再干预率为16.67%,患者术后的颈-臂症状评分均较术前明显降低(59.3±17.3 vs. 83.1±11.2,P<0.05),但术后McGill疼痛评分与术前差异无统计学意义(45.3±12.5 vs. 51.9±9.2,P>0.05),术后患者的桡动脉搏动较术前明显改善(P<0.05)。结论 Rotarex机械性减容联合药涂球囊是治疗动脉型TOS的一种微创、安全、有效的方法,具有良好的近期疗效,但是需要严格控制腔内介入手术的适应证,仔细筛选应用该种手术方式治疗动脉型TOS的患者,同时需要严密随访,中远期疗效仍有待于进一步地探究。

    Abstract:

    Background and Aims Thoracic outlet decompression with a subclavian artery bypass is considered to be the standard surgical procedure for arterial thoracic outlet syndrome (TOS), and it requires different surgical approaches for different locations of arterial compression. The efficacy of above surgery is reliable, and the long-term functional prognosis of the affected limb is usually satisfactory after surgery. However, above surgical procedure is technically difficult with a long learning curve, and will result in great trauma and many complications such as bleeding and nerve damage, as well as slow recovery of patients after the surgery. In recent years, the advancement of endovascular technology and the innovation of vascular devices have enabled a considerable number of vascular stenotic lesions to be effectively treated by interventional surgery. However, there are few previous reports on the use of endovascular techniques for the treatment of arterial TOS. Therefore, this study was to investigate the primary clinical efficacy of Rotarex mechanical debulking combined with drug-coated balloon (DCB) dilatation for arterial TOS, aiming to provide a new and reliable treatment approach for this condition.Method The clinical data of 6 patients with arterial TOS who underwent Rotarex mechanical debulking combined with DCB dilatation from January 2019 to December 2021 in Beijing Jishuitan Hospital were retrospectively analyzed. The surgical success rate, operative time, length of hospitalization, and surgical complications as well as the arterial patency rate and revascularization rate of the target lesion on postoperative 3 months were analyzed. The cervical brachial symptom and McGill pain questionnaire scores as well as the radial-artery pulses of the patients before and after operation were compared.Results In the 6 patients, the surgical success rate was 100%, the mean operative time was (52.3±18.7) min, mean length of hospitalization was (5.7±1.6) d, and mean intraoperative blood loss was (31.5±20.7) mL. There were no surgery-related complications. Three months after operation, the artery patency rate was 100%, and the revascularization rate of the target lesion was 16.67%. The postoperative cervical brachial symptom of the patients was significantly lower than that before operation (59.3±17.3 vs. 83.1±11.2, P<0.05), but the McGill pain questionnaire score of the patients showed no statistical difference with that before operation (45.3±12.5 vs.51.9±9.2, P>0.05), and the postoperative radial-artery pulse of the patients was significantly improved compared with preoperative status (P<0.05).Conclusion Rotarex mechanical debulking combined with DCB dilatation is a minimally invasive, safe and effective method for the treatment of arterial TOS with a satisfactory short-term effect. However, the indications for endovascular surgery should be strictly controlled, and the TOS patients undergoing this procedure should be carefully selected, and meanwhile timely follow-up is also needed. The mid- and long-term efficacy of this treatment method remains to be further observed.

    表 1 患者的临床资料Table 1 Clinical data of the patients
    图1 影像学资料 A:软组织压迫左锁骨下动脉致血管闭塞(白色箭头);B:软组织压迫右腋动脉致血管闭塞(白色箭头)Fig.1 Imaging data A: Vascular occlusion caused by soft tissue compression of left subclavian artery (white arrow); B: Vascular occlusion caused by soft tissue compression of the right axillary artery (white arrow)
    图2 术中照片 A:右腋动脉病变患者基线造影;B:Rotarex机械性减容后造影;C-D:右腋动脉行球囊扩张成形术及术后造影;E:上肢外展过伸位造影;F:左锁骨下动脉基线造影;G-H:左锁骨下动脉及腋动脉行球囊扩张成形术及术后造影Fig.2 Intraoperative images A: Baseline angiography of a patients with right axillary artery lesion; B: Angiography of the right axillary artery after Rotarex mechanical debulking; C-D: DCB dilatation of the right axillary artery and postoperative angiography; E: Radiography of the upper extremity in an abducted and extended position; F: Baseline angiography of a patients with left subclavian artery lesion; G-H: DCB dilatation of the left subclavian artery and postoperative angiography
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周密,蒋鹏,贾伟,张蕴鑫,程志远,田轩,李金勇,刘笑,田晨阳,刘建龙. Rotarex机械性减容联合药涂球囊治疗动脉型胸廓出口综合征的疗效分析[J].中国普通外科杂志,2022,31(6):728-734.
DOI:10.7659/j. issn.1005-6947.2022.06.004

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  • 收稿日期:2022-05-06
  • 最后修改日期:2022-06-03
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  • 在线发布日期: 2022-07-11