血栓闭塞性脉管炎合并动脉硬化闭塞导致下肢缺血的手术治疗  

Surgical treatment of lower limb ischemia due to combination of thromboangiitis obliterans and arteriosclerosis obliterans

作　　者：谷涌泉[1] 张建[1] 吴兵[2] 齐立行[1] 郭连瑞[1] 董小黎[3] 李建新[1] 俞恒锡[1] 李学锋[1] 崔世军[1] 吴英锋[1] 佟铸[1] 齐一侠[1] 汪忠镐[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 [2]辽宁省锦州市中心医院心血管外科 [3]首都医科大学病理教研室

出　　处：《中华普通外科杂志》2009年第5期380-382,共3页Chinese Journal of General Surgery

摘　　要：目的探讨下肢血栓闭塞性脉管炎（thromboangiitis obliterans，TAO）合并动脉硬化闭塞症（arteriosclerosis obliterans，ASO）手术治疗效果。方法回顾性分析2007年治疗的TAO合并ASO6例患者的资料。2例行腹主动脉切开取栓＋内膜剥脱＋腹主动脉-股深动脉人工血管旁路移植-腘动脉人工血管-小腿动脉自体大隐静脉旁路移植术，1例行腹主动脉切开取栓＋内膜剥脱＋腹主动脉-右股深动脉人工血管旁路移植-膝下腘动脉人工血管旁路移植术；1例行左髂总动脉-左股深动脉人工血管旁路移植-胫前动脉自体大隐静脉原位移植术，1例行左侧人工血管切开取栓＋左股深动脉成形-膝下腘动脉人工血管旁路移植术，1例行右股总动脉-左股总动脉人工血管旁路移植一胫后动脉自体大隐静脉旁路移植术。结果5例患者术后恢复顺利，1例于术后当天出现股动脉-腘动脉人工血管和远段的大隐静脉桥血栓形成，立即再次手术行人工血管和大隐静脉切开取栓术，并同时行胫后动静脉吻合。6例患者均痊愈出院，无死亡病例。5例患者的下肢远端静息痛完全缓解，1例部分缓解。足部溃疡的2例创面明显缩小，无感染发生。所有患者得到随访，平均随访为6．5个月，3例足部溃疡愈合。1例术后3个月出现左股部切口感染，最终行膝上截肢处理，残端一期愈合。其他5例患者的移植血管通畅，症状缓解。结论对TAO合并ASO患者如果手术治疗方式恰当，可以取得比较好的疗效。Objective To evaluate surgical treatment of lower limb ischemia due to combination of thromboangiitis obliterans （TAO） and arteriosclerosis obliterans （ASO）. Methods Clinical data of six patients suffering from lower limb ischemia due to TAO and ASO were retrospectively analyzed. All patients had a history of smoking, and complained of rest pain. Three patients had foot ulcer and one had toe gangrene. Two patients received aortic artery endarterectomy combined with PTFE graft bypass to deep femoral artery and below knee popliteal artery plus saphenous vein graft bypass to tibial artery. One patient received aortic thrombectomy and endarterectomy plus aortofemoral and femoropopliteal PTFE graft bypass. One patient with a history of left graft thrombosis after aorto-bifemoral arterial bypass using PTFE graft before admission underwent left PTFE graft thrombectomy via left groin and left deep femoral artery endarterectomy followed by femoropopliteal arterial bypass. One patient received left common iliac artery endarterectomy plus left profound femoral PTFE graft-left anterior tibial arterial bypass using in situ great saphenous vein graft. One patient received right to left femorofemoral arterial bypass using PTFE graft to left posterior tibial artety bypass using reversed great saphenous vein graft. Results One patient receiving aortoiliac thrombectomy and endarterectomy with aortofemoropopliteotibial arterial bypass suffered from graft thrombosis several hours after operation and emergency thrombectomy with distal posterior tibial arteriovenous fistulization was performed. The rest pain disappeared in 5 patients and partially relieved in one. All the grafts were patent on discharge. The foot ulcer reduced in 3 patients. All the 6 patients were followed up with a mean of 6. 5 months. 3 foot ulcers healed. One patient eventually received below knee amputation due to foot gangrene three months later. Conclusion Although it is difficult to treat combined limb ischemia of TAO and ASO, satisfactory results coul

关 键 词：血栓性脉管炎 闭塞 动脉硬化 闭塞性 缺血 下肢 动脉旁路移植 

分 类 号：R686[医药卫生—骨科学]