• 新疆維吾爾自治區(qū)人民醫(yī)院血管外科 (烏魯木齊 830001);

目的 探討動(dòng)脈切開(kāi)取栓術(shù)治療血栓閉塞性脈管炎(TAO)的臨床經(jīng)驗(yàn)。
方法 對(duì)我院2000年3月至2010年3月期間121例TAO患者中的14例（14條肢體: 上肢2例和下肢12例)行動(dòng)脈切開(kāi)取栓術(shù)，其中8例肢體行單純動(dòng)脈切開(kāi)取栓術(shù)，6例行同期動(dòng)脈切開(kāi)取栓聯(lián)合骨髓或外周血干細(xì)胞移植術(shù)。
結(jié)果 14例肢體中，11例肢體取栓成功，3例取栓不滿意。取栓成功患肢術(shù)后疼痛癥狀消失。成功取栓患者中7例獲得隨訪，隨訪5個(gè)月至8.5年（平均4年），其中4例間歇性跛行及靜息痛癥狀消失，2例未戒煙患者病情加重（1例行膝下截肢），1例已戒煙患者仍有間歇性跛行。3例遠(yuǎn)端取栓不成功的患者，1例失訪，1例術(shù)后未戒煙，癥狀加重行膝下截肢術(shù)，另1例已戒煙并隨訪3年，間歇性跛行等癥狀明顯改善。
結(jié)論 動(dòng)脈切開(kāi)取栓術(shù)是治療TAO安全、有效的方法。

引用本文： 戈小虎,賽力木,李雪松,任昊,慈紅波,方青波. 動(dòng)脈切開(kāi)取栓術(shù)治療血栓閉塞性脈管炎. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(7): 672-675. doi: 復(fù)制

1. Buerger L. Thromboangiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene [J]. Am J Med Sci, 1908; 136: 567580.
2. Fontaine R, Buck P, Riveaux R, et al. Treatment of arterial obliterations; respective value of thrombectomies and thromboendarteriectomies, of arteriovenous shunts, and of vascular grafts (fresh venous autografts) [J]. Lyon Chir, 1951; 46(1): 7394.
3. Shionoya S. Buerger’s Disease (thromboangiitis obliterans) [A]. In: Rutherford RB. Vascular Surgery [M]. 4th ed. Philadelphia: WB Saunders, 1994: 235245.
4. Fujii Y, Soga J, Nakamura S, et al. Classification of Corkscrew Collaterals in Thromboangiitis Obliterans (Buerger’s Disease) [J]. Circ J, 2010; 9(6): 11781183.
5. Piazza G, Creager MA. Thromboangiitis obliterans [J]. Circulation, 2010; 121(16): 18581861.
6. Espinoza LR. Buerger’s disease: thromboangiitis obliterans 100 years after the initial description [J]. Am J Med Sci, 2009; 337(4): 285286.
7. Abyshov NS, Zakirdzhaev EA, Aliev ZM. Modern aspects of diagnostics and treatment for thromboangiitis obliterans [J]. Khirurgiia (Mosk), 2009; (2): 7579.
8. 王玉琦, 史振宇. 我國(guó)血管外科的現(xiàn)狀與展望 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 387389.
9. Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease [J]. J Vasc Surg, 2004; 39(1): 176180.
10. 胡驥瓊,　王道明, 司春強(qiáng), 等. 下肢動(dòng)脈粥樣硬化閉塞癥截肢殘?bào)w的血管解剖及臨床意義 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 412415.
11. Zatevakhin II, Govorunov GV, Dobronravov DS, et al. Transplantation of the greater omentum using microsurgical technics in thromboangiitis obliterans [J]. Khirurgiia (Mosk), 1984; (5): 6166.
12. Vachev AN, Mikhaǐlov MS, Novozhilov AV. Microsurgical autotransplantation of the greater omentum to a lower limb in patients with critical ischaemia accompanying thromboangiitis obliterans [J]. Angiol Sosud Khir, 2008; 14(3): 107110.
13. Gordon A, Zechmeister K, Collin J. The role of sympathectomy in current surgical practice [J]. Eur J Vasc Surg, 1994; 8(2): 129137.
14. 馬震寰, 楊鏞, 楊國(guó)凱, 等. 下肢動(dòng)脈硬化閉塞癥繼發(fā)血栓形成治療分析 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(3): 275277.
15. Perlat A, Decaux O, Jégo P. Limb pain and pain in extremities. Diagnosis orientation [J]. Rev Prat, 2008; 58(16): 18211827.
16. 馬中, 邊杰芳, 袁時(shí)芳, 等. 一期動(dòng)靜脈轉(zhuǎn)流術(shù)在廣泛性下肢動(dòng)脈缺血循環(huán)重建中的應(yīng)用 [J]. 中國(guó)修復(fù)重建外科雜志, 2006; 20(12): 11681171.
17. 凌瑞, 易軍, 寧莫凡, 等. 脛后靜脈一期動(dòng)脈化治療周圍動(dòng)脈廣泛性閉塞性疾病 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6): 694696.
18. 薛蓮, 張培華. 血栓閉塞性脈管炎研究現(xiàn)況 [J]. 中華普通外科雜志, 1997; 12(5): 265266.
19. Sapoval MR, Long AL, Raynaud AC, et al. Femoropliteal stent placement longterm results [J]. Radiology, 1992; 184(3): 833839.
20. 谷涌泉, 齊立行, 張建, 等. 自體骨髓單個(gè)核細(xì)胞移植治療下肢缺血的中期療效 [J]. 中國(guó)修復(fù)重建外科雜志, 2009; 23(3): 341344.
21. 繆健航, 師天雄, 胡錫祥, 等. 自體外周血干細(xì)胞移植治療下肢動(dòng)脈缺血性疾病的臨床應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 106108.
22. Kajiguchi M, Kondo T, Izawa H, et al. Safety and efficacy of autologous progenitor cell transplantation for therapeutic angiogenesis in patients with critical limb ischemia [J]. Circ J, 2007; 71(2): 196201.
23. Saito Y, Sasaki K, Katsuda Y, et al. Effect of autologous bone marrow cell transplantation on ischemic ulcer in patients with Buerger’s disease [J]. Circ J, 2007; 71(8): 11871192.
24. 李雪松, 戈小虎, 賽力木, 等. 急性肢體動(dòng)脈栓塞手術(shù)治療（附47例報(bào)告） [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004; 11(2): 118.
25. 戈小虎, 管圣. 急性下肢動(dòng)脈栓塞的診斷及治療要點(diǎn) [J]. 外科理論與實(shí)踐, 2009; 14(3): 274277.
  1. 1. Buerger L. Thromboangiitis obliterans: a study of the vascular lesions leading to presenile spontaneous gangrene [J]. Am J Med Sci, 1908; 136: 567580.
  2. 2. Fontaine R, Buck P, Riveaux R, et al. Treatment of arterial obliterations; respective value of thrombectomies and thromboendarteriectomies, of arteriovenous shunts, and of vascular grafts (fresh venous autografts) [J]. Lyon Chir, 1951; 46(1): 7394.
  3. 3. Shionoya S. Buerger’s Disease (thromboangiitis obliterans) [A]. In: Rutherford RB. Vascular Surgery [M]. 4th ed. Philadelphia: WB Saunders, 1994: 235245.
  4. 4. Fujii Y, Soga J, Nakamura S, et al. Classification of Corkscrew Collaterals in Thromboangiitis Obliterans (Buerger’s Disease) [J]. Circ J, 2010; 9(6): 11781183.
  5. 5. Piazza G, Creager MA. Thromboangiitis obliterans [J]. Circulation, 2010; 121(16): 18581861.
  6. 6. Espinoza LR. Buerger’s disease: thromboangiitis obliterans 100 years after the initial description [J]. Am J Med Sci, 2009; 337(4): 285286.
  7. 7. Abyshov NS, Zakirdzhaev EA, Aliev ZM. Modern aspects of diagnostics and treatment for thromboangiitis obliterans [J]. Khirurgiia (Mosk), 2009; (2): 7579.
  8. 8. 王玉琦, 史振宇. 我國(guó)血管外科的現(xiàn)狀與展望 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 387389.
  9. 9. Ohta T, Ishioashi H, Hosaka M, et al. Clinical and social consequences of Buerger disease [J]. J Vasc Surg, 2004; 39(1): 176180.
  10. 10. 胡驥瓊,　王道明, 司春強(qiáng), 等. 下肢動(dòng)脈粥樣硬化閉塞癥截肢殘?bào)w的血管解剖及臨床意義 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6): 412415.
  11. 11. Zatevakhin II, Govorunov GV, Dobronravov DS, et al. Transplantation of the greater omentum using microsurgical technics in thromboangiitis obliterans [J]. Khirurgiia (Mosk), 1984; (5): 6166.
  12. 12. Vachev AN, Mikhaǐlov MS, Novozhilov AV. Microsurgical autotransplantation of the greater omentum to a lower limb in patients with critical ischaemia accompanying thromboangiitis obliterans [J]. Angiol Sosud Khir, 2008; 14(3): 107110.
  13. 13. Gordon A, Zechmeister K, Collin J. The role of sympathectomy in current surgical practice [J]. Eur J Vasc Surg, 1994; 8(2): 129137.
  14. 14. 馬震寰, 楊鏞, 楊國(guó)凱, 等. 下肢動(dòng)脈硬化閉塞癥繼發(fā)血栓形成治療分析 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(3): 275277.
  15. 15. Perlat A, Decaux O, Jégo P. Limb pain and pain in extremities. Diagnosis orientation [J]. Rev Prat, 2008; 58(16): 18211827.
  16. 16. 馬中, 邊杰芳, 袁時(shí)芳, 等. 一期動(dòng)靜脈轉(zhuǎn)流術(shù)在廣泛性下肢動(dòng)脈缺血循環(huán)重建中的應(yīng)用 [J]. 中國(guó)修復(fù)重建外科雜志, 2006; 20(12): 11681171.
  17. 17. 凌瑞, 易軍, 寧莫凡, 等. 脛后靜脈一期動(dòng)脈化治療周圍動(dòng)脈廣泛性閉塞性疾病 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(6): 694696.
  18. 18. 薛蓮, 張培華. 血栓閉塞性脈管炎研究現(xiàn)況 [J]. 中華普通外科雜志, 1997; 12(5): 265266.
  19. 19. Sapoval MR, Long AL, Raynaud AC, et al. Femoropliteal stent placement longterm results [J]. Radiology, 1992; 184(3): 833839.
  20. 20. 谷涌泉, 齊立行, 張建, 等. 自體骨髓單個(gè)核細(xì)胞移植治療下肢缺血的中期療效 [J]. 中國(guó)修復(fù)重建外科雜志, 2009; 23(3): 341344.
  21. 21. 繆健航, 師天雄, 胡錫祥, 等. 自體外周血干細(xì)胞移植治療下肢動(dòng)脈缺血性疾病的臨床應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(2): 106108.
  22. 22. Kajiguchi M, Kondo T, Izawa H, et al. Safety and efficacy of autologous progenitor cell transplantation for therapeutic angiogenesis in patients with critical limb ischemia [J]. Circ J, 2007; 71(2): 196201.
  23. 23. Saito Y, Sasaki K, Katsuda Y, et al. Effect of autologous bone marrow cell transplantation on ischemic ulcer in patients with Buerger’s disease [J]. Circ J, 2007; 71(8): 11871192.
  24. 24. 李雪松, 戈小虎, 賽力木, 等. 急性肢體動(dòng)脈栓塞手術(shù)治療（附47例報(bào)告） [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2004; 11(2): 118.
  25. 25. 戈小虎, 管圣. 急性下肢動(dòng)脈栓塞的診斷及治療要點(diǎn) [J]. 外科理論與實(shí)踐, 2009; 14(3): 274277.