下肢动脉搭桥术后人工血管闭塞的治疗  

Management of prosthetic graft occlusion after lower extremity bypasses

作　　者：李清乐[1] 张小明[1] 张学民[1] 沈晨阳[1] 

机构地区：[1]北京大学人民医院血管外科,100044

出　　处：《中华医学杂志》2010年第33期2334-2337,共4页National Medical Journal of China

摘　　要：目的探讨下肢动脉搭桥术后人工血管闭塞的治疗方法及疗效。方法回顾性分析自2004年10月至2009年10月治疗的下肢动脉搭桥术后人工血管闭塞53例临床资料，共计104例次闭塞，10例末次闭塞保守治疗，其余94例次手术治疗：单纯人工血管取栓术26例次，再次搭桥或延长搭桥术23例次，人工血管取栓并球囊扩张术18例次，截肢术14例次，人工血管取栓术并股动脉或膪动脉内膜剥脱术10例次，2例人工血管闭塞并感染取出后保守治疗，自体干细胞移植1例次。结果77例次血运重建手术，49例次术后人工血管再次闭塞（63．6％）。6例失访；47例患者平均随访（29．8±17．1）个月，其中10例死亡（21．3％），12例人工血管闭塞后截肢（25．5％），25例患者保肢（53．2％），其中18例患者人工血管通畅（38．3％），7例闭塞保守治疗（14．9％）。生存分析显示本组3年生存率77．4％，保肢率64．7％，累积通畅率45．7％，重建术式对通畅时间的影响无统计学意义。结论下肢动脉人工血管搭桥术后闭塞血运重建术后再闭塞率及截肢率较高，应根据具体情况选择恰当治疗方式。Objective Report the experience of management of graft occlusion in patients with lower extremity bypasses and discuss the appropriate treatment strategy. Methods From Oct. 2004 to Oct. 2009, 104 cases of graft occlusion were treated in 53 patients with lower extremity arterial bypasses, including medical therapy for 10 cases and redo operations for 94 cases： graft thrombectomy alone for 26 cases, redo bypass or extension bypass with prosthetic or autologous vein grafts for 23 cases, graft thrombectomy plus balloon angioplasty for 18 cases ,major amputation for 14 cases, graft thrombectomy plus femoral or popliteal artery endarterectomy for 10 cases, removal of occluded graft with infection for 2 case, and autologous stem cell transplantation for 1 case. Results 77 reconstructive procedures were applied and graft failures recurred in 49 cases （63.6%）. One patient died of acute renal failure during peri-operaitve period and 9 patients died during follow-up; 6 patients were lost to follow-up. The remaining 37 patients were followed： major amputation for 12 patients, patent grafts after reconstruction in 18 patients, and medical therapy after graft occlusion for 7 patients with limb salvage. Kaplan-Meier survival analysis revealed 3-year survival of 77.4% , limb salvage of 64.7% , and graft patency of 45.7% . Effect of different procedures on cumulative patency was of no statistical significance. Conclusions Graft occlusions after lower extremity bypasses may result in high rate of reocclusion and amputation. Optimal management should be based on a thorough analysis of individual condition.

关 键 词：下肢 搭桥手术 人工血管 闭塞 

分 类 号：R654.3[医药卫生—外科学]