下肢血栓闭塞性脉管炎的治疗  

Therapy of Thromboangitis Obliterans of Lower Extremities

作　　者：陈幸生[1] 林挺[1] 官云彪[1] 李南[1] 

机构地区：[1]福建医科大学附属协和医院血管外科,福州350001

出　　处：《中国普外基础与临床杂志》2010年第7期653-655,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨下肢血栓闭塞性脉管炎(TAO)的治疗。方法自1994年3月至2009年2月期间我院对24例患者的26条有严重慢性缺血表现的下肢,经Doppler超声与DSA、CTA或MRA检查,确诊为下肢TAO。根据影像提示的病变部位与程度不同,分别用以下方式治疗:①19例患者(21条下肢)行静脉动脉化手术治疗;②3例患者(3条下肢)行血管腔内介入治疗;③2例患者(2条下肢)行动脉切开取栓手术。结果 19例患者(21条下肢)静脉动脉化术后随访1～14.5年(平均5.6年),13条患肢症状不同程度好转,可基本正常生活。术前ABI为0.38±0.11,术后6个月为0.79±0.08,差异有统计学意义(P<0.05)。手术有效率为61.9%(13/21),截肢率23.8%(5/21)。3例患者(3条下肢)行血管腔内介入治疗,其中1条失败后改行低位深组静脉动脉化手术;2例患者(2条下肢)行动脉切开取栓成功;术后随访1～4年(平均1.8年),均无截肢。结论根据病变部位与程度,选择合适的治疗方法是提高疗效的关键。静脉动脉化手术是治疗下肢TAO的有效方法 。Objective To explore the treatment of thromboangitis obliterans （TAO） of lower extremities.Methods From March 1994 to February 2009,24 cases （26 limbs） affected by chronic ischemia were diagnosed as TAO by Doppler ultrasound and DSA,CTA or MRA.According to the different levels of the extensive and diffuse arterial occlusion,the revascularization was performed in the ways：19 cases （21 limbs） underwent venous arterialization,3 cases （3 limbs） underwent endovascular therapy,and 2 cases （2 limbs） underwent thrombectomy.ResultsAfter the venous arterialization,19 cases （21 limbs） were followed up for 1 to 14.5 years.Apart from the 5 limbs amputation （23.8%）,the postoperative results of the most limbs were satisfactory （61.9%）.The ABI before therapy （0.38±0.11） was significantly lower than that 6 months after therapy （0.79±0.08）,P0.05.In 3 cases （3 limbs） underwent endovascular therapy,one case failed and then received the venous arterialization.Two cases （2 limbs） finished thrombectomy successfully.After endovascular therapy and thrombectomy,these 4 cases were followed up for 1 to 4 years without the amputation.Conclusion In order to improve the curative effect,it is important to choose the suitable therapeutic strategy according to the different levels of the extensive and diffuse arterial occlusion.The venous arterialization is an effective treatment for TAO of lower extremities.

关 键 词：下肢 血栓闭塞性脉管炎 静脉动脉化 介入治疗 取栓术 

分 类 号：R654.4[医药卫生—外科学]