远端动脉旁路移植附加动静脉吻合治疗严重下肢缺血21例  

Treatment of severe lower extremity ischemia with distal bypass and arteriovenous anastomosis

作　　者：谷涌泉[1] 张建[1] 齐立行[1] 汪忠镐[1] 俞恒锡[1] 李建新[1] 李学锋[1] 郭连瑞[1] 崔世军[1] 罗涛[1] 陈兵[1] 董宗俊[1] 

机构地区：[1]首都医科大学宣武医院血管外科首都医科大学血管外科研究所,北京100053

出　　处：《中华普通外科杂志》2005年第9期578-580,共3页Chinese Journal of General Surgery

基　　金：北京市优秀人才基金首都医学发展基金资助项目(2002-1013)

摘　　要：目的探讨严重下肢动脉病变伴有远端流出道动脉不通畅的动脉旁路移植手术方法,以避免截肢或降低截肢平面。方法分析2000年7月至2004年12月采用动脉旁路移植手术并辅助远端吻合口处的动静脉吻合治疗的21例(21条患肢)下肢远端流出道动脉不良患者的临床资料。结果21例患者中,除1例因为远端动脉的“虚灌”而再次手术外,其余患者均一次手术成功,成功率95·2%。出院时血管通畅率100%,足部创面的愈合率33·3%。结论伴有远端流出道动脉不良的严重缺血,在下肢动脉血流重建中采用远端吻合口的动静脉吻合可以明显提高血管的通畅率,可以达到避免截肢或降低截肢平面的目的。Objective To explore the effectiveness of distal arterial bypass for the treatment of severe lower limb ischemia with poor outflow artery. Method From July 2000 to Dec 2004, we treated 21 cases （21 limbs） of severe lower limb ischemia with poor outflow artery by distal bypass with additional arteriovenous anastomosis at or distal to the distal graft anastomosis. Results Among the 21 cases, one case received reoperation for “void arterial perfusion” distal to the arteriovenous anastomosis. The operative success rate was 95.2%. The patency rate of graft was 100% and the healing rate of foot ulcer was 33.3% on discharge. Conclusion Additional areriovenous anastomosis at or distal to the distal graft anastomosis can dramatically increase the patency rate of the graft when outflow artery is too poor to guarantee a patent grafting in the case of severe lower limb ischemia, although long-term effectiveness needs to be varified.

关 键 词：远端动脉旁路移植术 动静脉吻合 下肢缺血 截肢手术 动脉闭塞性疾病 

分 类 号：R654.3[医药卫生—外科学]