股腘动脉病变腔内治疗与外科血管旁路移植术疗效分析  

A comparison for the patency rate of TASC Ⅱ C/D femoropopliteal arterial disease between endovascular treatment and arterial bypass therapy

作　　者：王丙龙 王国涛 杨睿 

机构地区：[1]山西省运城市中心医院血管外科,044000

出　　处：《中华医学杂志》2015年第14期1100-1103,共4页National Medical Journal of China

摘　　要：目的比较泛大西洋协作组织（TASC）ⅡC、D型股胭动脉病变腔内治疗与外科血管旁路移植术的临床疗效。方法回顾分析2009年1月至2014年1月山西省运城市中心医院92例（97条肢体）TASCⅡC、D型股胭动脉病变患者腔内治疗与外科血管旁路移植术临床资料，男58例，女34例，年龄56-86岁，平均年龄（68±9岁），〉70岁的患者52例（56．5％）。Rmherford分期：Ⅲ期（重度间歇跛行）51条肢体，Ⅳ期（静息痛）33条肢体，Ⅴ期（溃疡）10条肢体，Ⅵ期（坏疽）3条肢体。总结分析腔内治疗和外科血管旁路移植术技术成功率、围手术期并发症发生率、死亡率、靶血管通畅率、保肢率以及手术前后踝肱指数（ABI）。结果腔内治疗技术成功率96．0％，严重并发症发生率8．6％，围手术期死亡率0％，ABI由术前（0．40±0．16）升至术后的（0．72±0．24），两者差异有统计学意义（t=-7．842，P〈0．05）。血管旁路移植术技术成功率95．4％，严重并发症发生率15．9％，围手术期死亡率4．5％，ABI由术前（0．36±0．19）升至（0．76±0．21），两者差异有统计学意义（P〈0．05）。术后24个月一期通畅率：腔内治疗组为67．4％，旁路移植术组为71．4％，2组差异无统计学意义（X^2=3．694，P〉0．05）；术后24个月累计通常率：腔内治疗组为79．0％，旁路移植术组为79．4％，2组差异无统计学意义（X^2=3．463，P〉0．05）。术后24个月的累计保肢率：腔内治疗组为93．o％，旁路移植术组92．3％，2组差异无统计学意义（X^2=2．642，P〉0．05）。结论TASCⅡCD型股胭动脉病变腔内治疗可以获得同外科血管旁路移植术相当的一期、二期通畅率和保肢率，但其创伤小，并发症发生率低，死亡率低，可作为首选治疗方法。Objective To compare the long term outcome of The Trans-Atlantic Inter-Society Consensus（TASC） Ⅱ C/D femoropopliteal arterial disease between endovascular treatment and arterial bypass therapy. Methods A retrospective study was undertaken on 92 patients （97 limbs ） receiving endovascular treatment and graft bypass therapy for TASC Ⅱ C/D femoropopliteal arterial disease from January 2009 to January 2014, 58 male and 34 female. Mean age was （68 ±9） years （range, 56 years to 86 years） , 52 patients over 70 years old （occupied 56. 5% ）. Severe intermittent claudieation, rest pain, minor tissue defect and foot ulceration or gangrene were in 51 limbs, 33 limbs, 10 limbs and 3 limbs, respectively. Technical success rate, perioperative complication rate, mortality rate, patency rate and limb salvage rate, ankle braehial index （ABI） were evaluated. Results Technical success rate of endovascular treatment was 96. 0%, severe complication rate was 8. 6%. No death cases at perioperative period, preoperative ABI was （0.40±0. 16）, postoperative ABI increase to （0.72±0. 24）. Technical success rate of graft bypass therapy was 95.4%, severe complication rate was 15.9%, perioperative mortality rate was 4. 5%, preoperative ABI was （0. 36±0. 19） , postoperative ABI increase to （0. 76±0. 21 ）. Primary term patency rate, cumulative patency rate and cumulative limb salvage rate at 24 months of endovascular treatment were 67.4% , 79. 0% and 93.0% respectively. Graft bypass therapy were 71.4% , 79.4% and 92. 3% respectively. Conclusion Endovascular treatment of TASC Ⅱ C/D femoropopliteal arterial disease has the same patency rate and limb salvage rate to graft bypass therapy, lesions is microinvasive, safe and effective.

关 键 词：腘动脉 血管成形术 血管移植 气囊 支架 

分 类 号：R654.3[医药卫生—外科学]