下肢动脉血管旁路移植术后再闭塞的影响因素分析  

Multivariate analysis of prosthetic graft occlusion after lower extremity bypasses

作　　者：耿家威 胡何节[1] 方征东[1] 王晓天[1] 孙小杰[1] 

机构地区：[1]安徽医科大学附属省立医院血管外科,合肥230001

出　　处：《中国临床保健杂志》2017年第4期349-353,共5页Chinese Journal of Clinical Healthcare

基　　金：安徽省自然科学基金(1408085MH177)

摘　　要：目的分析影响下肢动脉血管旁路移植术后再闭塞的危险因素。方法回顾性分析80例下肢动脉粥样硬化闭塞症患者血管旁路移植术的临床资料,术后1、3、6、9、12个月以及以后每半年复查下肢血管B超、CT血管造影检查,必要时行数字减影血管造影(DSA)检查。对术后血管闭塞发展情况进行分析总结,探讨影响下肢动脉血管旁路移植术后再闭塞的因素。结果手术成功率100%(80/80),围手术期1例病例因术后突发急性脑梗死脑疝死亡,80例患者中首次术式:股动脉—腘动脉(膝上)血管搭桥术62例(77.5%),股动脉—腘动脉(膝下)血管搭桥术18例(22.5%),其中9例使用自体大隐静脉(11.2%),12例使用直径6 mm人工血管(15%),59例使用直径8 mm人工血管(73.8%)。41例患者合并高血压(51.2%),16例患者合并糖尿病(20%),13例患者合并心脏疾病病(16.2%),9例患者合并脑血管病史(11.2%)。随访率为86.9%(80/92),随访时间为1~60个月,随访期病死率为11.2%(9/80)。术后闭塞37例(46.2%),术后通畅43例(53.8%),术后死亡病例9例,其中2例死于突发脑梗死,3例死于脑出血,其余4例死于心血管疾病。结论糖尿病、术前评估流出道小于2根、术中选择直径6 mm人工血管和行膝下搭桥手术是患者术后再闭塞的危险因素。Objective To summarize the recovery of lower extremity artery bypass surgery by analyzing the ca- ses treated in our department, and to explore the influencing factors of graft occlusion after lower extremity arterial by- pass;for lower extremity arteriosclerosis obliterans patients with lower extremity vascular bypass effect with evidence- based medicine. Methods A retrospective analysis of the clinical data of 80 cases of lower extremity atherosclerosis was performed , cases were followed by 1,3,6,9,12 M, and thereafter, every half year review of lower extremity vascular ul- trasound, CTA examination, DSA examination if necessary, tosummarize the development of postoperative vascular occlu- sion, and to explore the factors that affect the re occlusion after arterial bypass grafting. Results The success rate of op- eration was 100% （80/80） ,one died of sudden death of acute cerebral infarction with cerebral hernia During periop- erative case phase first operation of 80 cases were distributed as follows： the femoral artery, popliteal artery （knee） in 62 cases of vascular bypass （ 77. 5% ）, femoral artery and popliteal artery （ knee ） in 18 cases of vascular bypass （22. 5% ） ,including 9 cases using autologous saphenous vein （ 11.2% ）, 12 cases with 6mm diameter artificial blood vessel （15%） ,59 cases with 8ram diameter artificial blood vessel （73.8%）. All the 80 patients were followed up. 41 patients with hypertension （51.2%） ,16 cases of patients with diabetes mellitus （20%） ,13 cases of patients with heart disease （ 16.2% ） ,9 cases of patients with cerebral vascular disease （ 11.2% ） were recorded. Postoperative occlusion occurred in 37 cases （46.2%） and postoperative patency in 43 cases （53.8%）. Conclusions The risk of occlusion is higher in the patients with diabetes mellitus before operation,which are the ePTFE graft of 6mm in diameter,femoral- Donliteal bvnass （below knee ） or the number of outflow less than two.

关 键 词：闭塞性动脉硬化 血管移植术 下肢 复发 危险因素 

分 类 号：R654.4[医药卫生—外科学]