腘以远动脉闭塞所致下肢严重缺血的血供重建  

Reconstructive options for critical limb ischaemia in infrapopliteal arteries

作　　者：陆信武[1] 叶开创[1] 李维敏[1] 黄英[1] 陆民[1] 黄新天[1] 刘晓兵[1] 殷敏毅[1] 施慧华[1] 蒋米尔[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科上海交通大学血管病诊治中心,上海 200011

出　　处：《中华普通外科杂志》2011年第3期192-194,共3页Chinese Journal of General Surgery

基　　金：上海市卫生局科研课题基金资助项目（2007061）

摘　　要：目的评价胭以远动脉闭塞所致下肢严重缺血（critical limbischemia，CLI）的血供重建。方法回顾性分析2003年12月至2009年1月，胭以远动脉闭塞所致CLI行经皮血管腔内成形（pereutaneous transluminal angioplasty，PTA）和开放性重建（open reconstruction，OR）术的患者，详细记录患者的病史、病变特点、手术过程、并发症和随访信息。采用Kaplan—Meier生存分析重建血管通畅率和救肢率。结果本组胭以远动脉闭塞所致CLI患者共167例，182条患肢。123条动脉硬化闭塞（arterios－clerosisocclusions，ASO）的患肢行胭以远动脉PTA治疗，33条血栓闭塞性脉管炎（thromboangiitisobliterans，TAO）和23条ASO患肢行胭以远动脉OR手术。PTA再管化通道6、12、24个月的通畅率分别是67％、54％和49％，其救肢率分别是91％、85％和78％，OR术后移植物6、12、24个月的通畅率分别是90％、83％和79％，其救肢率分别是92％、87％和80％，PTA重建血管的通畅率低于开放性手术（P〈0．05），但PTA和OR术的救肢率差异无统计学意义（P〉0．05）。结论对胭以远动脉ASO的CLI患者，PTA有效、安全，可作为首选治疗方式。PTA治疗失败可选择OR术。对TAO患者胭以远动脉闭塞者OR术仍是最好的治疗选择。Objective To assess reconstructive options for critical limb ischaemia in infrapopliteal arteries. Methods A retrospective review of all CLI patients who underwent infrapopliteal reconstruction was carried out. Patient history, demographics, procedure details, complications, and follow-up information were collected and analyzed. Patency, limb salvage rate was determined by Kaplan-Meier analysis. Results During the period （from December 2003 to January 2008）, 123 CLI patients with arteriosclerosis occlusions were treated on an intention-to-treat basis with infrapopliteal percutaneous transluminal angioplasty （PTA）. Thirty-three thromboangiitis obliterans and twenty-three arteriosclerosis occlusions suffering CLI were treated by infrapopliteal bypass procedures. Primary patency and limb salvage rate of infrapopliteal PTA at 6, 12 and 24 months was 67%, 54%, 49% and 91%, 85%, 78% respectively, Primary patency and limb salvage rate of infrapopliteal surgical bypass at 6, 12 and 24 months was 90%, 83%, 79% and 92%, 87%, 80% respectively, the patency of infrapopliteal PTA was lower than infrapopliteal surgical bypass （P 〈0. 01 ）, but the limb salvage rate of infrapopliteal PTA and open surgery was no significant difference （P 〉 0. 05）. Conclusion Endovascular treatment （PTA） in patients with infrapopliteal arteriosclerosis occlusions and critical ischaemia is safe, effective. Infrapopliteal PTA can be used as the choice of therapy and surgical bypass reserved in those endovascular treatment failed. While in CLI patients with thromboangiitis obliterans infrapopliteal artery bypass remains the best treatment option.

关 键 词：动脉闭塞性疾病 血管成形术 下肢 旁路术 

分 类 号：R654.3[医药卫生—外科学]