膝下动脉硬化闭塞症腔内治疗的效果分析  

Efficacy of Endovascular Treatment for Arteriosclerosis Obliterans in the Infrapopliteal Arteries

作　　者：王中华[1] 庄百溪[2] 陈学东[1] 王育红[1] 田磊[1] 王仕华[1] 姜福亭[1] 

机构地区：[1]海军总医院普通外科,北京100048 [2]中国中医科学院西苑医院血管外科,北京100091

出　　处：《中国微创外科杂志》2011年第3期233-236,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经皮腔内血管成形结合支架植入术对膝下动脉硬化闭塞症的治疗效果。方法回顾性分析我院2005年10月~2009年5月182例（210条肢体）膝下动脉硬化闭塞症的临床资料,采用常规或内膜下成形技术对狭窄或闭塞性病变进行球囊扩张,38条肢体在胫腓干植入冠脉支架。结果 195条肢体获得影像学成功（残余狭窄率〈30%）,技术成功率为92.9%（195/210）。并发症主要有动脉穿孔（3例）、痉挛（4例）、管壁夹层（6例）及穿刺点血肿（5例）,给予相应处理后缓解。182例术后肢体疼痛、麻凉感等临床症状均改善,踝/肱指数（AB I）由术前的0.40±0.11增至术后7 d的0.83±0.15（t=33.50,P〈0.0001）。术后6、12个月肢体血流通畅率分别为89.0%（187/210）和73.3%（154/210）,术后12个月肢体保全率和存活率分别为91.4%（192/210）、93.3%（196/210）。结论腔内治疗膝下动脉硬化闭塞症的临床成功率高、并发症少、保肢率高,是安全有效的治疗方法。Objective To investigate the value of percutaneous transluminal angioplasty（PTA） and stenting in the treatment for arteriosclerosis obliterans of the infrapopliteal arteries. Methods Between October 2005 and May 2009,in our hospital,182 patients（210 limbs） with arteriosclerosis obliterans in the infrapopliteal arteries received conventional or subintimal angioplasty for balloon dilatation of the stenotic or occlusive vessels;38 of the patients underwent PTA plus stenting in the tibiofibular artery.Results Angiographic success was achieved in 195 limbs（postoperative rate of stenosis 30%）,and clinical success rate was 92.9%（195/210）.The main complications in our patients included arterial perforation（3 limbs）,spasm（4 limbs）,arterial dissection（6 limbs） and hematoma in the puncture site（5 limbs）.All the complications were cured by conservative treatments.After the operation,182 patients＇ symptoms of pain and numbness were improved,with an ABI increased from 0.40±0.11 before the operation to 0.83±0.15 at day 7 after the treatment（t=33.50,P0.0001）.The rate of vascular patency at 6 and 12 months was 89.0%（187/210） and 73.3%（154/210） respectively.And the limb salvage rate and survival rate were 91.4%（192/210） and 93.3%（196/210） respectively at month 12 after the operation. Conclusions Endovascular treatment is a safe and effective method for arteriosclerosis obliterans in the infrapopliteal arteries,yielding high clinical success with a low complication rate and high limb salvage rate.

关 键 词：经皮腔内血管成形术 膝下动脉 硬化闭塞 

分 类 号：R654.3[医药卫生—外科学]