两种手术方式治疗膝下动脉闭塞性病变的临床疗效对比  

Clinical efficacy comparison of two surgical methods in the treatment of infrapopliteal artery occlusive disease

作　　者：张红松 胡延伟 张磊[1] 张峰[1] 贺新奇[1] 彭军路[1] 何兆鹏 郑丽华[1] 杨立新 杨艳 ZHANG Hong-song;HU Yan-wei;ZHANG Lei;ZHANG Feng;HE Xin-qi;PENG Jun-lu;HE Zhao-peng;ZHENG Li-hua;YANG Li-xin;YANG Yan(Department of General Surgery,First Hospital of Hebei Medical University,Shijiazhuang Hebei 050011,China;Department of General Surgical,Xingtai Third Hospital,Xingtai Hebei 054000,China;Department of General Surgery,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]河北医科大学第一医院普外科,河北石家庄050011 [2]邢台市第三医院普外科,河北邢台054000 [3]首都医科大学宣武医院普外科,北京100053

出　　处：《局解手术学杂志》2021年第3期214-218,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省卫健委2018年医学科学研究重点课题计划项目(20180243)。

摘　　要：目的探讨腔内血管成形术与下肢动脉旁路移植术治疗膝下动脉闭塞性病变的临床疗效。方法选取膝下动脉闭塞性病变患者343例作为研究对象,其中142例行下肢动脉旁路移植术(旁路移植组),201例行腔内血管成形术(血管成形组)。采用1∶1倾向性评分,以血管成形组为基准组进行匹配,共67例匹配成功。分析2组肢体挽救率、靶血管一期通畅率、踝肱指数(ABI)、Rutherford分级评分及并发症发生情况。结果2组肢体挽救率、靶血管一期通畅率比较,差异均无统计学意义(P>0.05)。2组术前ABI、Rutherford分级评分比较,差异无统计学意义(P>0.05);但重复测量结果显示,以时间因素为作用主效应差异有统计学意义(P<0.05);2组术后7 d、6个月ABI均高于术前(P<0.05),但同一时间点组间比较差异无统计学意义(P>0.05);2组术后7 d、6个月Rutherford分级评分均低于术前(P<0.05),但同一时间点组间比较差异无统计学意义(P>0.05)。血管成形组并发症发生率明显低于旁路移植组(P<0.05)。结论腔内血管成形术与下肢动脉旁路移植术治疗膝下动脉闭塞性病变,患者的肢体挽救率、靶血管一期通畅率相当,但腔内血管成形术并发症相对较少。Objective To explore the clinical efficacy of percutaneous transluminal angioplasty and lower limb artery bypass grafting in the treatment of infrapopliteal artery occlusive disease.Methods A total of 343 patients with infrapopliteal artery occlusive disease were enrolled,including 142 patients who underwent lower limb artery bypass grafting(bypass grafting group)and 201 patients who underwent percutaneous transluminal angioplasty(angioplasty group).The angioplasty group was selected as the baseline group for 1:1 propensity score matching,and a total of 67 cases were successfully matched.And the limb salvage rate,primary patency rate of the target vessels,ankle-brachial index(ABI),Rutherford grading scores and complications in the two groups were analyzed.Results The differences of the limb salvage rate and primary patency rate of the target vessels between the two groups were not statistically significant(P>0.05).The differences of preoperative ABI and Rutherford grading score between the two groups were not statistically significant(P>0.05).However,repeated measurement results showed that there was a statistically significant difference in the main effect of time factor(P<0.05).ABI of the two groups 7 days and 6 months after operation were significantly higher than those before operation(P<0.05),but there was no significant difference between the two groups at the same time point(P<0.05).Rutherford grading scores of the two groups 7 days and 6 months after operation were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups at the same time point(P<0.05).The complication rate of the angioplasty group was significantly lower than that of the bypass grafting group(P<0.05).Conclusion Percutaneous transluminal angioplasty and lower limb artery bypass grafting in the treatment of infrapopliteal artery occlusive disease have similar limb salvage rate and primary patency rate of the target vessels,but percutaneous transluminal angioplasty has relatively

关 键 词：腔内血管成形术 下肢动脉旁路移植术 膝下动脉闭塞性病变 肢体挽救率 踝肱指数 Rutherford分级 

分 类 号：R858.3[医药卫生—航空、航天与航海医学]