腔内治疗与自体静脉转流术治疗血栓闭塞性脉管炎膝下动脉闭塞的疗效评价分析  

Compariosn of endovascular therapy and autogenous venous bypass for thromboangiitis obliterans patients with the below-the-knee arterial occlusion

作　　者：杨心蕊[1] 叶开创[1] 施慧华[1] 秦金保[1] 殷敏毅[1] 刘晓兵[1] 李维敏[1] 蒋米尔[1] 陆信武[1] YANG Xin-rui;YE Kai-chuang;SHI Hui-hua;QIN Jin-bao;YIN Min-yi;LIU Xiao-bing;LI Wei-min;JIANG Mi-er;LU Xin-wu(Department of Vascular Surgery,Shanghai Ninth People＇s Hospital,Shanghai Jiaotong University School of Medicine,Vascular Center of Shanghai Jiaotong University,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院血管外科上海交通大学血管病诊治中心,上海200011

出　　处：《中国血管外科杂志（电子版）》2018年第2期109-112,共4页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金(81700432);申康医院发展中心新兴前沿项目(SHDC12015112);上海交通大学医学院附属第九人民医院临床研究助力计划(JYLJ019)

摘　　要：目的对比腔内治疗与自体静脉转流术对膝下动脉闭塞的血栓闭塞性脉管炎(TAO)患者的临床疗效。方法回顾性分析2010年1月至2016年12月上海交通大学医学院附属第九人民医院血管外科行腔内治疗与自体静脉转流术的膝下动脉闭塞的TAO患者,对比两种方法的围术期并发症、早期失败率、保肢率、通畅率及溃疡愈合时间等。结果共纳入83例患者,96条肢体,其中腔内治疗组40例(47条肢体),自体静脉转流组43例(49条肢体),所有患者均有严重肢体缺血(CLI)表现。平均随访时间为26个月(3~48个月),总体保肢率为88.54%(85/96),共11条肢体因症状加重接受踝上截肢术。腔内治疗组保肢率为87.23%,自体静脉转流组89.80%,差异无统计学意义(P>0.1)。一期通畅率腔内治疗组1年为51.43%,3年为19.00%;二期通畅率1年为65.13%,3年为47.89%。自体静脉转流组一期通畅率1年为71.24%,3年为60.52%;二期通畅率1年为80.98%,3年为68.87%。腔内治疗组通畅率较自自体静脉转流组低(P<0.01)。溃疡愈合时间腔内治疗组为(4.5±3.1)个月,自体静脉转流组为(3.2±2.4)个月,腔内治疗组溃疡愈合时间较自体静脉转流组长(P=0.047)。结论腔内治疗的保肢率与自体静脉转流术相当,尽管通畅率较低,但再次治疗程序简单,创伤小。特别是对于缺乏膝下流出道或合适大隐静脉移植物的患者,是一种有效的治疗方法,可供选择。Objective Aim to compare the outcomes of endovascular therapy （ET） vs autogenous venous bypass （AVB） for the below-the- knee （BTK） arterial occlusion in thromboangiitis obliterans （TAO） patients with critical limb ischemia （CLI）. Methods A total of 96 limbs in 83 TAO patients, successfully treated with ET （ET group, 40 patients, 47 limbs） and AVB （AVB group, 43 patients, 49 limbs） for the BTK arterial occlusions from January 2010 to December 2016 in our institution were retrospectively analyzed. The characteristics and outcomes were compared between the two groups. The outcomes were the amputation-free rate, patency rates, immediate failure, periprocedural complications, and clinical improvement. Results During a mean follow-up duration of 26 months （3-48 month）, the amputation-free rate was 88.54%（85/ 96）, ET group was 87.23% and AVB group was 89.80%（P〉0.1）. Patients in the ET group had a significantly lower primary patency rate （51.43% at 1 year and 19.00% at 3 year in ET group vs 71.24% and 60.52% in AVB group; P〈0 .001 separately）.The mean time for ulcer healing was 4.5±3.1 months in the ET group and 3.2±2.4 months in the AVB group （P=0.045）, showing a longer time for ulcer healing in the ET group. Conclusions ET is an alternative strategy for limb salvage in TAO patients who are unsuitable for bypass, contributing an acceptable amputation-free rate as high as with AVB, even though it isassociated with lower patency rates and a higher rate of reintervention.

关 键 词：血栓闭塞性脉管炎 膝下动脉闭塞 腔内治疗 自体静脉转流术 

分 类 号：R654.4[医药卫生—外科学]