药物涂层球囊与普通球囊治疗下肢动脉硬化闭塞症支架置入术后支架内再狭窄的疗效对比  

Drug-coated balloon vs standard angioplasty balloon in the treatment of postoperative in-stent restenosis in patients with arteriosclerosis obliterans of the lower extremity

作　　者：宋涛[1] 孙勇[1] 聂中林[1] 唐文波[1] 徐超[1] 余朝文[1] Song Tao;Sun Yong;Nie Zhonglin;Tang Wenbo;Xu Chao;Yu Chaowen(Department of Vascular Surgery,the First Affiliated Hospital,Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院血管外科,安徽省233004

出　　处：《中华普通外科杂志》2021年第5期350-354,共5页Chinese Journal of General Surgery

基　　金：安徽省重点研究与开发计划项目(201904a07020020)。

摘　　要：目的:对比分析药物涂层球囊(DCB)与普通球囊在下肢动脉硬化闭塞症(ASO)支架术后再狭窄(ISR)治疗中的临床疗效。方法:收集2017年1月至2018年12月期间本院血管外科收治的下肢ASO支架术后ISR患者43例,根据治疗方式分为2组:行DCB血管成形术18例为DCB组,行普通球囊血管成形术(SAB)25例为SAB组,术后随访6~12个月。比较2组患者的并发症及主要不良事件(MAE)发生情况、靶病变血管通畅率、临床驱动靶病变再次血运重建(CD-TLR)率以及Rutherford分级,测定踝肱指数(ABI)、血浆P选择素、内皮素-1(ET-1)和一氧化氮(NO)。结果:DCB组与SAB组的并发症发生率差异无统计学意义(P>0.05)。术后6、12个月,DCB组的Rutherford分级≥2级率均低于SAB组(P<0.05)。术后6、24 h和2周,DCB组的血浆ET-1低于SAB组,高于SAB组(P<0.05),但P选择素比较差异无统计学意义(P>0.05)。术后3 d、6和12个月,2组的ABI值均升高,且术后6、12个月时DCB组高于SAB组(P<0.05)。术后6、12个月,DCB组的管腔丢失明显低于SAB组(P<0.05)。术后6、12个月,DCB组的靶血管通畅率为100.00%、88.89%,高于SAB组的72.00%、52.00%(P<0.05);DCB组的CD-TLR率为11.11%,低于SAB组的48.00%(P<0.05)。结论:DCB治疗下肢ASO支架术后IRS疗效优于SAB。Objective To compare drug-coated balloon(DCB)and standard angioplasty balloon(SAB)in the treatment of postoperative in-stent restenosis(ISR)in patients with arteriosclerosis obliterans(ASO)of the lower extremity.Methods From)an 2017 to Dec 2018,43 ISR patients after percutaneous transluminal angioplasty for ASO of the lower extremity at our hospital were enrolled.Patients were divided into 2 groups with 18 patients treated by DCB and 25 by SAB.The patients were followed up for 6〜12 months.Results There was no significant difference in the incidence of complications between DCB group and SAB group(P>0.05).Compared with that in SAB group,the plasma level of ET-1 in DCB group was lower while NO was higher at 6,24 h and 2 weeks after surgery(P<0.05),there was no significant difference in P-selectin(P>0.05).The ABI values in both groups increased,and that in DCB group were higher than SAB group at 6 and 12 months after surgery(P<0.05).The lumen loss in DCB group at 6 and 12 months after surgery was significantly lower(P<0.05).At 6 and 12 months,the primary patency of target lesions in the DCB group was 100.00%and 88.89%,which was higher than the 72.00%and 52.00%in the SAB group(P<0.05);the CD-TLR rate in the DCB group was 11.11%,which was lower than 48.00%in the SAB group(P<0.05).Conclusion DCB comes with lower postoperative ISR in ASO patients of the lower extremity.

关 键 词：动脉闭塞性疾病 支架 药物涂层球囊 

分 类 号：R654.4[医药卫生—外科学]