股腘动脉病变球囊扩张与支架植入的疗效对比研究  

Percutaneous transluminal angioplasty versus stent implantation for treatment of femoral and popliteal artery lesion resulted from arteriosclerosis obliterans

作　　者：庄金满[1] 李选[1] 李天润[1] 傅军[1] 栾景源[1] 王昌明[1] 

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《北京大学学报（医学版）》2016年第1期160-165,共6页Journal of Peking University:Health Sciences

摘　　要：目的：比较单纯经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）与PTA联合支架植入两种方法治疗股腘动脉病变的近、远期疗效。方法：回顾性分析2003年1月至12月北京大学第三医院收治的95例（107条患肢）股腘动脉病变患者的临床资料,根据患者接受的治疗方式,将其分为PTA组（单纯PTA,60条患肢）和支架组（PTA联合支架植入,47条患肢）,采用门诊和电话问诊方式随访。结果：PTA组60条患肢中22条为单纯股腘动脉病变,13条合并髂动脉病变,17条合并膝下动脉病变,8条合并髂动脉及膝下动脉病变;支架组47条患肢中18条为单纯股腘动脉病变,8条合并髂动脉病变,15条合并膝下动脉病变,6条合并髂动脉及膝下动脉病变。两组患者的年龄、性别构成、合并症、治疗前踝肱指数及Rutherford分级差异均无统计学意义（P〉0.05）,但PTA组中泛大西洋协作组（Trans-Atlantic Inter-Society Consensus,TASC）C/D级所占比例低于支架组（58.3%vs.76.6%,P=0.047）。PTA组和支架组随访时间分别48.0（5.0,108.0）个月和40.0（3.0,96.0）个月,差异无统计学意义（P=0.064）。支架组治疗费用及近期总有效率明显高于PTA组[（33 882.7±8 695.6）元vs.（17 754.8±3 654.2）元,P〈0.001;93.6%vs.80.0%,P=0.044];近期显效率尽管略高于PTA组,但差异无统计学意义（31.9%vs.21.7%,P=0.231）;近期有效率以及并发症发生率与PTA组相比差异无统计学意义（58.3%vs.58.3%,P=0.724;1.7%vs.2.1%,P=1.000）;两组均无近期恶化及围术期死亡病例。支架组远期显效率低于PTA组,恶化率高于PTA组,但差异均无统计学意义（8.5%vs.15.0%,P=0.381;14.9%vs.5.0%,P=0.081）;两组远期总有效率、累积保肢率及再手术率差异无统计学意义（66.0%vs.66.7%,P=0.939;94.7%vs.94.1%,P=0.884;31.9%vs.31.7%,P=1.000）。两组1~10年一期及二期累积通畅率差异无统计学意义（P=0.837,P=0.622）。进一步分组比较表明,支�Objective： To study the clinical effects of percutaneous transluminal angioplasty （PTA） versus stent implantation （ST） after PTA for the treatment of femoral and popliteal artery lesion resulted from arteriosclerosis obliterans. Methods： One hundred and three patients （119 limbs） treated for femo- ral and popliteal artery lesion resulted from arteriosclerosis obliterans for ten years were reviewed, of whom 60 limbs were treated by PTA and the other 47 by PTA combined with stent implantation. Results： Among the 60 limbs of the PTA group, there were 22 limbs involved only in femoral and popliteal artery; 13 limbs combined with iliac artery lesion; 17 limbs combined with infrapopliteal artery lesion; 8 limbs combined with iliac and infrapopliteal artery lesion. Among the 47 limbs of the ST group, there were 18 limbs involved only in femoral and popliteal artery; 8 limbs combined with iliac artery lesion; 15 limbs combined with infrapopliteal artery lesion; 6 limbs combined with iliac and infrapopliteal artery lesion. There was no significant difference between the two groups on age, sex, concomitant disease, ankle bra- chial index（ABI） before treatment and Rutherford classification （P 〉 0.05 ）. The patients＇ Trans-atlantic inter-society consensus （TASC） C/D was lower in the PTA group than that in the ST group （58.3 % vs. 76.6%, P =0.047）. The follow-up periods were 48.0 （5.0,108.0） and 40.0 （3.0,96.0） monthsrespectively （P = 0. 064）. Compared with the PTA group, the ST group had a better short-term total effective rate （93.6% vs. 80.0%, P = 0. 044 ） and a higher cost [ （33 882.7 ± 8 695.6） yuan vs. （17 754.8±3 654.2） yuan, P 〈0. 001 ]. The short-term marked effective rate of the ST group was higher than that of the PTA group, but the difference was not significant （31.9% vs. 21.7%, P = 0.231 ）. There was no significant difference between the two groups on short-term efficiency, and compli- cation rates （58.3% vs. 58.3%, P =0.724; 1.7% vs. 2.1%,

关 键 词：动脉硬化 闭塞性 股动脉 腘动脉 血管成形术 支架 

分 类 号：R654.3[医药卫生—外科学]