杂交手术治疗下肢闭塞性动脉硬化合并急性缺血患者的临床效果  

Effect of hybrid surgery in patients with lower extremity arteriosclerosis obliterans complicated with acute limb ischemia

作　　者：卓华威 陈小宇 张卫刚 陶银煜 秦怡 孙洋 李晓强 毛由军 Zhuo Huawei;Chen Xiaoyu;Zhang Weigang;Tao Yinyu;Qin Yi;Sun Yang;Li Xiaoqiang;Mao Youjun(Department of Vascular Surgery,Changzhou Second People's Hospital Affiliated Nanjing Medical University,Changzhou 213000,Jiangsu,China;Department of Vascular Surgery,Nanjing Drum Tower Hospital Affiliated Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京医科大学附属常州第二人民医院血管外科,江苏常州213000 [2]南京大学医学院附属鼓楼医院血管外科,江苏南京210008

出　　处：《血管与腔内血管外科杂志》2022年第3期304-308,共5页Journal of Vascular and Endovascular Surgery

基　　金：国家自然科学基金(81770483);常州市卫健委青年人才科技项目(QN202031)。

摘　　要：目的探讨杂交手术治疗下肢闭塞性动脉硬化(ASO)合并急性缺血(ALI)的临床效果。方法收集2018年1月至2020年6月南京医科大学附属常州第二人民医院收治的41例ASO合并ALI患者(45条患肢)的临床资料,均进行杂交手术治疗,观察患者的手术情况、不良事件发生率、技术成功率、临床成功率。术后1、3、12个月进行门诊随访,评估患者的生存率、保肢率、靶血管一期通畅率。结果15.6%(7/45)患肢行股动脉斑块内膜剥脱处理,其中4.4%(2/45)股动脉行人工血管补片成形术。45条患肢动脉均行普通球囊逐级扩张处理,其中22.2%(10/45)患肢动脉因残余狭窄置入自膨式裸支架,6.7%(3/45)患肢动脉因限制性夹层置入自膨式裸支架。主要不良事件发生率为7.3%(3/41),技术成功率为100%(45/45),临床成功率为95.6%(43/45)。术后1、3、12个月生存率分别为97.6%(40/41)、95.1%(39/41)、90.2%(37/41),保肢率分别为95.5%(42/44)、90.7%(39/43)、85.4%(35/41),靶血管一期通畅率为90.9%(40/44)、86.0%(37/43)、80.5%(33/41)。结论杂交手术吸取了开放手术和腔内治疗的优点,近期随访结果满意,是治疗ASO合并ALI的安全有效手段。Objective To investigate the clinical effect of hybrid surgery in the treatment of lower extremity arteriosclerosis obliterans(ASO)complicated with acute limb ischemia(ALI).Method A total of 41 patients with ASO and ALI(45 affected limbs)admitted to Changzhou Second People's Hospital Affiliated Nanjing Medical University from January 2018 to June 2020 were collected.All patients underwent hybrid surgery,the surgical conditions,adverse events,technical success rates,and clinical success rates were observed.Outpatient follow-up was performed at 1,3,and 12 months after the surgery to evaluate the overall survival,limb salvage rate,and primary patency rate of target vessels.Result 15.6%(7/45)of the affected limbs underwent femoral artery plaque endarterectomy,of which 4.4%(2/45)underwent femoral artery combined with artificial angioplasty.The 45 affected limb arteries were all treated with ordinary balloon dilatation step by step,of which 22.2%(10/45)of the affected limb arteries were placed with self-expandable bare stents due to residual stenosis,and 6.7%(3/45)of the affected limb arteries were due to restriction.A self-expanding bare stent was placed in the interlayer.The incidence of major adverse events was 7.3%(3/41),the technical success rate was 100%(45/45),and the clinical success rate was 95.6%(43/45).At 1,3 and 12 months after surgery,the survival were 97.6%(40/41),95.1%(39/41),90.2%(37/41),respectively;the limb salvage rates were 95.5%(42/44),90.7%(39/43),85.4%(35/41),respectively;the primary patency rates of target vessels were 90.9%(40/44),86.0%(37/43),and 80.5%(33/41),respectively.Conclusion Hybrid surgery draws on the advantages of open surgery and endovascular treatment,the recent follow-up results are satisfactory.Therefore,it is a safe and effective treatment for ASO complicated with ALI.

关 键 词：杂交手术 下肢闭塞性动脉硬化 急性缺血 

分 类 号：R543[医药卫生—心血管疾病]