完全性锁骨下动脉硬化闭塞外科治疗单中心67例临床分析  

Surgical treatment of total subclavian artery occlusion: a single center experience of 67 cases

作　　者：张永保 滕乐群 房杰 曲诚家 刘新农 沈晨阳 Zhang Yongbao;Teng Lequn;Fang Jie;Qu Chengjia;Liu Xinnong;Shen Chenyang(Ward 1 of Aortic,Vascular Surgery Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院血管中心一病区,100037

出　　处：《中华外科杂志》2020年第11期852-857,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81870350);首都卫生发展科研专项基金(2018-2Z-4037)。

摘　　要：目的探讨锁骨下动脉完全闭塞患者的外科治疗方式及效果。方法回顾性分析2016年1月至2019年7月中国医学科学院阜外医院血管中心一病区收治的67例锁骨下动脉硬化闭塞疾病的患者的临床资料。男性51例,女性16例,年龄(61.7±8.2)岁(范围:37~79岁)。根据患者身体状况、手术意愿、主动脉弓Myla分型及病变是否近椎动脉等情况,采用开放手术或腔内手术进行治疗。采用t检验、Mann-Whitney U检验、χ^2检验或Fisher确切概率法分析腔内治疗技术成功率的相关因素。采用Kaplan-Meier法计算累积通畅率并绘制相应生存曲线,Log-rank检验进行组间比较。以锁骨下动脉近心端残端长度为变量绘制腔内治疗开通与否的受试者工作特征曲线,通过约登指数确定残端长度的最佳截点值。结果18例患者接受开放手术;49例患者采用腔内治疗尝试开通闭塞血管,左侧病变38例,右侧病变11例,34例成功开通;15例开通失败患者中,10例择期行开放手术,5例保守治疗。腔内治疗技术成功率为69.4%(34/49),左侧为81.6%(31/38),右侧为3/11。腔内开通成功患者中,锁骨下动脉硬化闭塞近心端残端长度≥6 mm的比例高于开通失败者(23/34比4/15,χ^2=5.506,P=0.019)。腔内治疗组1例术后发生左胸外侧皮下出血,开放手术组术后1例发生淋巴漏。随访3~46个月,中位随访时间22个月,术后12、24个月累积通畅率腔内治疗组为92.6%、82.9%,开放手术组为90.8%、84.3%。吸烟患者腔内治疗术后24个月累积通畅率低于不吸烟患者(70.2%比100%,P=0.048)。Cox比例风险模型中没有发现锁骨下动脉闭塞患者术后通畅率的独立预后因素。结论腔内治疗可用于治疗部分符合条件的锁骨下动脉硬化闭塞患者,左侧比右侧腔内治疗成功率更高,锁骨下动脉近心端残端长度与技术成功率有关。Objective To examine the outcomes of surgical repair for patients with total subclavian artery occlusion.Methods A retrospective analysis was performed on 67 patients with subclavian artery occlusion disease admitted at Ward 1 of Aortic and Vascular Surgery Center,Fuwai Hospital from January 2016 to July 2019.The age was,and There were 51 male patients and 16 females with an age of(61.7±8.2)years(range:37 to 79 years).The t-test,Mann-Whitney U-test,χ^2 test,and Fisher's exact test were used to analyze the factors related to the technique success.The Kaplan-Meier curve was used to calculate the cumulative patency rate and plot the corresponding survival curves,and the Log-rank test was used for comparison.The length from the subclavian artery ostial to the occlusion area was used as a variable to plot the receiver operating characteristic curve,and the optimal cut-off value was determined by the Youden index.Results Eighteen patients received open surgery.Forty-nine patients with subclavian artery occlusion accepted endovascular repair,of which 38 patients succeeded(31 cases on left side and 3 cases on right side).Fifteen patients failed with endovascular therapy,of which 10 cases received elective surgery and 5 cases received conservative therapy.The success rate of endovascular repair was 69.4%(34/49).Among them,the success rate of left subclavian artery occlusion was 81.6%(31/38),while the right side was 3/11.Patients with the length from the subclavian artery ostial to the occlusion area≥6 mm were more likely to get success(23/34 vs.4/15,χ^2=5.506,P=0.019).In the endo-group,one patient had hemorrhage in the left chest.In the open-group,one patient had lymphatic leakage.Follow-up period ranged from 3 to 46 months with a median of 22 months.The patency of endovascular repair group and the open surgery group was 92.6%and 90.8%at 12-month,while 82.9%and 84.3%at 24-month,respectively.The cumulative patency rates of smoking patients and non-smoking patients after endovascular treatment were 70.2%vs.100%(P=0.048

关 键 词：动脉闭塞性疾病 锁骨下动脉 锁骨下动脉窃血综合征 支架 

分 类 号：R654.4[医药卫生—外科学]