腔内及杂交手术治疗主髂动脉硬化闭塞症  

Endovascular Treatment and Hybrid Surgery for Aortoiliac Occlusive Disease

作　　者：张建彬[1] 徐荣伟[1] 甄亚楠 刘鹏[1] 叶志东[2] 

机构地区：[1]北京协和医学院研究生院,北京100073 [2]中日友好医院心脏血管外科,北京100029

出　　处：《中国微创外科杂志》2016年第2期110-113,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：科技部国际合作项目(2013DFA31900)

摘　　要：目的 探讨主髂动脉硬化闭塞症的腔内及杂交手术治疗效果。方法回顾性分析我科2010年1月～2013年12月腔内及杂交手术治疗主髂动脉硬化闭塞症90例资料，根据Rutherford分级，1级6例，2级7例，3级32例，4级27例，5级18例。共植入支架230枚，同时行动脉旁路移植13例，内膜剥脱20例，取栓5例。结果90例均成功完成手术。术后1周Ruthedbrd分级较术前提高1级29例，2级33例，3级14例，与术前相同14例。术后1周ABI从术前的0．37±0．19提高至0．86±0．86（t=30．480，P=0．000）。围手术期死亡1例（1．1％），穿刺部位血肿4例，[足母]趾坏疽1例，不稳定型心绞痛1例，人工血管血栓形成1例，切口脂肪液化2例。随访12～50个月，（15．7±8．8）月，一期通畅率85．4％（70／82），二期通畅率96．3％（79／82）。结论主髂动脉硬化闭塞症腔内治疗效果良好，部分复杂患者可应用杂交技术。Objective To explore the curative effect of endovaseular treatment and hybrid surgery for aortoiliac occlusiw disease. Methods A retrospective analysis was performed on 90 cases of aortoiliae occlusive disease in our center from January 2010 to December 2013. According to the Rutherford category, there were 6 grade 1 cases, 7 grade 2 cases, 32 grade 3 cases, 27 grade 4 cases, and 18 grade 5 cases. A total of 230 stents were implanted, with 13 cases of arterial bypass grafting, 20 cases of endarterectomy and 5 cases of thrombectomy. Results All the proeedurcs were completed successfully. At the first week after surgery, 29 patients had 1 grade improvement of the Rutherford category, 33 patients had 2 grade improvement, and 14 patients have 3. Among the remaining 14 cases, the Rutherford category was unchanged as compared to preoperation. The ankle-brachial index was inereased from 0.37 ±0.19 preoperatively to 0.86 ±0.86 one week postoperatively （t = 30. 480, P = 0. 000）. There was I death in peri-operative time and the mortality rate was 1.1%. Complications included 4 cases of hematoma in the puncture site, 1 case of gangrene of the fool, 1 ease of unstable angina, 1 ease of thrombus formation in the artificial bypass and 2 eases of fat liquefaction of the incision. During tollow-ups for 12 -50 months （mean, 15.7 ± 8.8 months） , the primary pateney rate was 85.4% （70/82） and the secondary pateney rate was 96.3% （79/82）. Conclusion Endovascular treatment has good outcomes for patients with aortoiliae occlusive disease. In complieated eases, hybrid technique can be used.

关 键 词：动脉硬化闭塞症 主髂动脉 腔内成形 支架 

分 类 号：R654.3[医药卫生—外科学]