股腘动脉人工血管旁路术中膝周肌瓣构建侧支血管在下肢动脉硬化闭塞症治疗中的应用与观察  

Application and observation on the treatment of lower extremity arteriosclerosis occlusion by constructing collateral vessels with muscle flap during femoral popliteal artery artificial vascular bypass

作　　者：胡骥琼[1] 薛清泉[1] 梁双超[1] Hu Jiqiong;Xue Qingquan;Liang Shuangchao(Department of Vascular Surgery,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院附属弋矶山医院血管外科,芜湖241001

出　　处：《中华解剖与临床杂志》2022年第7期502-506,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽省教育厅自然科学研究计划(2002KJ310);皖南医学院中青年科研基金(WK200446B);安徽省卫建委医学科研课题(09A024)。

摘　　要：目的探讨股腘动脉人工血管旁路术中膝周肌瓣构建对下肢动脉硬化闭塞症(ASO)患者术后人工血管闭塞后膝下血供的代偿作用。方法回顾性描述性研究。选取皖南医学院附属弋矶山医院血管外科2012年6月—2020年7月ASO患者31例,其中男22例、女9例,年龄52~87(72.3±3.6)岁。均为单侧肢体病变,左侧14例、右侧17例,Rutherford分期3级以上,踝肱指数(ABI)为0.32±0.13。均行股腘动脉人工血管旁路术治疗,术中将离断的腓肠肌内侧头与同侧的半膜肌、半腱肌及缝匠肌瓦合叠加缝合,以膝周肌瓣构建侧支血管。术后,在超声检查人工血管闭塞(无血流信号)后,观察患者肢体缺血情况,同时观察并比较患者手术前后ABI;出院时按照Rutherford标准评价患者手术疗效;随访期间观察并统计患者截肢率,观察成功保肢患者的生活状态。结果31例患者手术均顺利完成,无围术期死亡患者。术后1周ABI为0.58±0.19,高于术前的0.32±0.13,差异有统计学意义(t=3.02,P=0.002)。出院时手术疗效评价:显著有效15例、有效10例、无效4例、恶化2例。术后随访6~60个月,平均24.6个月。患者在人工血管闭塞后,下肢虽有一过性疼痛、发凉等缺血症状,但经抗凝治疗症状缓解。术后2、24个月分别有1例患者死于心肌梗死,术后3年1例死于脑梗死,生前均无下肢静息痛症状,可作室内活动;2例因股深动脉多节段闭塞、膝下组织血供不足,分别于术后6、15个月行截肢术,余26例患者成功保肢,随访6个月~5年,均无需行临床再干预,均无静息痛。结论股腘动脉旁路术治疗的ASO患者,采用腓肠肌肌瓣在膝周构建侧支血管,在人工血管闭塞后,下肢缺血无明显加重,说明肌瓣构建对缓解患者膝下肢体缺血状态有一定的作用。Objective To investigate the compensatory effect of perigenicular muscle flap construction during femoral popliteal artery artificial vascular bypass on subgenicular blood supply in patients with arteriosclerotic occlusive disease(ASO).Methods In this retrospective descriptive study,31 ASO patients were selected from the Vascular Surgery Department of Yijishan Hospital,which is affiliated to Wannan Medical College,from June 2012 to July 2020 for inclusion.All patients,including 22 males and 9 females aged 52-87(72.3±3.6)years old,had unilateral limb lesions.Their Rutherford stage was 3 or above,and ankle-brachial index(ABI)was 0.32±0.13.Eight cases had diabetes,14 cases had hypertension,and 9 cases had hypertension and diabetes.All patients were treated with femoral popliteal artery artificial vascular bypass,in which the severed medial head of the gastrocnemius was sutured with imbricate sutures of ipsilateral semimembrane,semitendinosus,and sartorius muscles.Collateral vessels were constructed with perigenicular muscle flaps.After surgery,the artificial blood vessel occlusion(no blood flow signal)was examined by ultrasound,and the limb ischemia of the patient was observed.Meanwhile,ABI before and after operation was observed and compared.The amputation rate of the patient was measured,and the living status of the patients with successful limb salvage was observed.Result All 31 patients successfully completed the operation with no perioperative death.ABI at 1 week after surgery was(0.58±0.19),which was higher than that before surgery(0.32±0.13),and the difference was statistically significant(t=3.02,P=0.002).Postoperative follow-up lasted from 6 months to 60 months,with an average of 24.6 months.Although the patient had transient ischemia symptoms after the occlusion of artificial blood vessels,he recovered via anticoagulation treatment and functional exercise.Two patients died of myocardial infarction at 2 and 24 months after surgery respectively,and another died of cerebral infarction 3 years after the sur

关 键 词：闭塞性动脉硬化 下肢缺血 动脉旁路术 肌瓣构建 侧支循环 

分 类 号：R654.4[医药卫生—外科学]