髂股动脉损伤外科手术方式与疗效分析  

Surgical methods and clinical efficacy analysis of iliac-femoral artery injuries

作　　者：余婧 袁时芳 陈江浩 王辉 崔风强 石文龙 Yu Jing;Yuan Shifang;Chen Jianghao;Wang Hui;Cui Fengqiang;Shi Wenlong(Department of Breast-Thyroid-Vascular Surgery,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,Shannxi,China)

机构地区：[1]空军军医大学第一附属医院甲乳血管外科,陕西西安710032

出　　处：《血管与腔内血管外科杂志》2022年第3期298-303,330,共7页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨髂股动脉损伤的手术方式与临床疗效。方法收集2008年8月至2020年8月空军军医大学第一附属医院收治的95例髂股动脉损伤患者的临床资料。根据术前合并症、动脉损伤情况、伤口污染程度及远端肢体血供情况采取不同的手术方式。观察所有患者的手术情况并进行分组。比较采取不同手术方式治疗患者的临床特征。根据患者术前基线情况、术后复查结果,随访下肢血管彩色多普勒超声及踝肱指数(ABI),评估下肢动脉远端血运情况、支架通畅情况及术后患肢功能恢复情况。采用视觉模拟评分量表(VAS)对患者术前、术后及末次随访时的疼痛情况进行评价。结果95例髂股动脉损伤患者中,共77例患者进行手术治疗,包括开放手术55例(开放手术组)和腔内手术22例(腔内手术组)。截肢患者12例,截肢率为12.6%(12/95)。两组患者的年龄、性别、术前心脑血管并发症发生率、术前有无合并感染、平均住院时间比较,差异均无统计学意义(P>0.05);开放手术组患者术前失血性休克、骨折的患者比例均高于腔内手术组患者,手术时间、ICU住院时间长于腔内手术组患者,术中出血量多于腔内手术组患者,差异均有统计学意义(P<0.05)。腔内手术组患者末次随访时与本组术后的VAS评分比较,差异无统计学意义(P>0.05)。两组患者末次随访时与本组术后的ABI比较,差异均无统计学意义(P>0.05)。结论外科手术是髂股动脉损伤的主要治疗方法,尤其适用于合并骨折、失血性休克及伤口污染的患者。与开放手术相比,腔内手术治疗髂股动脉损伤安全有效,具有创伤小、手术时间短、术后恢复快等优点,在充分掌握手术适应证的前提下可以作为首选。Objective To evaluate the surgical methods and clinical efficacy of iliac-femoral artery injuries.Method The clinical data of 95 patients with iliac-femoral injuries admitted to the First Affiliated Hospital of Air Force Medical University from August 2008 to August 2020 were collected.Different surgical methods were adopted according to the preoperative complications,arterial injury,wound pollution and distal limb blood supply.The surgery conditions of all patients were observed and these patients were grouped.The clinical characteristics of patients treated with different surgical methods were compared.According to the preoperative baseline and postoperative reexamination results,the outpatient department followed up the color Doppler ultrasound and ankle brachial index(ABI)of lower limb vessels to evaluate the distal blood supply of lower limb arteries,the patency of stents and the functional recovery of affected limbs after operation.Visual analogue scale(VAS)was used to evaluate the pain before,after and at the last follow-up.Result Among the 95 patients with iliac-femoral artery injuries,77 patients were treated by surgery,including 55 patients in the open surgery group and 22 patients in the endovascular surgery group.There were 12 patients with amputation,and the amputation rate was 12.6%(12/95).There was no significant difference in age,sex,incidence of preoperative cardiovascular and cerebrovascular complications,preoperative coinfection and average hospital stay between between the two groups(P>0.05).The proportion of patients with preoperative hemorrhagic shock and fracture in the open surgery group was higher than that in the endovascular surgery group,the surgery time and ICU hospitalization time were longer than those in the endovascular surgery group,and the amount of intraoperative bleeding was more than those in the endovascular surgery group(P<0.05).There was no significant difference in VAS scores of patients in endovascular repair group at the last follow-up and after surgery(P<0.05).There wa

关 键 词：髂股动脉 血管损伤 腔内手术 视觉模拟评分量表 踝肱指数 临床疗效 

分 类 号：R543.5[医药卫生—心血管疾病]