多点穿刺技术在股腘动脉闭塞TASCⅡC、D级病变腔内治疗的诊治分析  

Multi-point puncture for endovascular treatment of Trans Atlantic Inter-Society Consensus Ⅱ C and D occlusive lesions in the femoropopliteal artery

作　　者：王伟明 张雷 何虎强 孙晓磊 曾宏 胥雄飞 施森 刘勇 WANG Weiming;ZHANG Lei;HE Huqiang;SUN Xiaolei;ZENG Hong;XU Xiongfei;SHI Sen;LIU Yong(Department of Vascular Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sich.uan Province,China)

机构地区：[1]西南医科大学附属医院血管外科,四川泸州646000

出　　处：《西南医科大学学报》2018年第2期154-157,共4页Journal of Southwest Medical University

摘　　要：目的:探讨多点次穿刺技术在下肢股腘动脉长段闭塞[泛大西洋协作组织(TASC)ⅡC、D级]病变腔内的应用及临床治疗效果。方法:回顾分析2013年12月至2015年12月西南医科大学附属医院血管外科38例(45条患肢)住院患者的临床资料,对多点穿刺技术入路的选择、围手术期的并发症及死亡率、手术前后踝肱指数的比较等进行分析。结果:38例(45条患肢)患者共行多点穿刺49次,其中经腘动脉P3段穿刺14次,经胫前动脉穿刺11次,经胫腓干穿刺3次,经胫后动脉穿刺8次,经腓动脉穿刺9次,经足背动脉穿刺4次;经腔内治疗后出院前踝肱指数为0.89±0.17,较术前0.31±0.14明显好转,在术后3月、6月、12月随访期间,其踝肱指数分别为0.77±0.20、0.71±0.15、0.61±0.11;一期通畅率在术后3月、6月、12月分别为93.3%、88.1%、79.2%。结论:血管腔内治疗是目前下肢动脉硬化性闭塞症的主要治疗方法,然而针对股腘动脉长段闭塞(TASCⅡC、D级)病变的治疗来说,多点穿刺技术的应用可以增加腔内手术成功的几率,但其远期的临床疗效有待进一步观察。Objective:To explore the application of multi-point puncture in the endovascular treatment of long-segment occlusive lesions in the femoropopliteal artery of lower limbs and its clinical therapeutic effect.Methods:The clinical data of 38 patients(45 affected limbs)in the department of vascular surgery,the affiliated hospital of Southwest Medical Univesity,from December 2013 to December 2015 were analyzed retrospectively.The approach of multi-point puncture,perioperative complications and mortality,and ankle-brachial index before and after surgery were analyzed.Results:Thirty-eight patients(45 limbs)underwent multi-point puncture 49 times,including 14 times in the P3 segment of the popliteal artery,11 times in the anterior tibial artery,3 times in the tibiofibular trunk,8 times in the posterior tibial artery,9 times in the peroneal artery,and 4 times in the dorsalis pedis artery.After endovascular treatment,the ankle-brachial index was 0.89±0.17 before discharge,which was significantly higher than the preoperative value 0.31±0.14.The ankle-brachial index was 0.77±0.20,0.71±0.15,and 0.61±0.11 at 3,6,and 12 months postoperatively,respectively.The primary patency rate was 93.3%,88.1%,and 79.2%at 3,6,and 12 months postoperatively,respectively.Conclusion:Endovascular treatment is the main treatment for Arteriosclerosis obliterans of lower limbs.However,for long-segment occlusive lesions in the femoropopliteal artery(TransAtlantic Inter-Society ConsensusⅡC and D),multi-point puncture can increase the successful rate of endovascular surgery,but its long-term clinical efficacy needs to be further observed.

关 键 词：多点穿刺 动脉硬化性闭塞症 腔内治疗 外周动脉疾病 泛大西洋协作组织 

分 类 号：R654.3[医药卫生—外科学]