主髂动脉闭塞症开放手术与腔内治疗中远期疗效比较  

Comparison of medium-and long-term efficacy of open surgery and endovascular therapy for aortoiliac occlusive disease

作　　者：王鼎 贾龙元 赵成东 王雷[1] 李璇[1] 姜波[1] 伦语[1] 荆玉辰[1] 胡新华[1] 张健[1] 辛世杰[1] Wang Ding;Jia Longyuan;Zhao Chengdong;Wang Lei;Li Xuan;Jiang Bo;Lun Yu;Jing Yuchen;Hu Xinhua;Zhang Jian;Xin Shijie(Department of Vascular Surgery,The First Affiliated Hospital of China Medical University,Shenyang 110002,China)

机构地区：[1]中国医科大学附属第一医院血管外科,沈阳110002

出　　处：《中华血管外科杂志》2023年第1期32-36,共5页Chinese Journal of Vascular Surgery

基　　金：国家自然科学基金(81974049)。

摘　　要：目的分析主髂动脉闭塞症(AIOD)开放手术与腔内治疗的中远期疗效。方法回顾性分析中国医科大学附属第一医院2010年1月至2020年1月收治的92例TASCⅡC/D型AIOD患者的临床资料,根据手术方式分为开放手术组(38例)和腔内治疗组(54例),比较两组的围术期和随访期结果。采用Kaplan-Meier法和log-rank检验比较两组术后通畅率和累积生存率。结果90例患者取得技术成功,技术成功率为97.8%,85例(92.4%)患者症状得到改善。8例(8.7%)出现围术期并发症,开放手术组并发症发生率高于腔内治疗组(15.8%比3.7%,χ^(2)=4.103,P=0.043)。89例(96.7%)患者获得随访,随访时间为(92.67±21.74)个月(范围:6.4~120.0个月)。开放手术组5和10年的一期通畅率高于同期腔内治疗组(5年:91.5%比85.2%;10年:78.4%比77.9%),差异具有统计学意义(log-rankχ^(2)=5.126,P=0.040),而二期通畅率两组差异无统计学意义(P=0.102)。两组术后复发率、再狭窄率、保肢率及生存率方面,差异无统计学意义(均P>0.05)。结论腔内治疗组并发症发生率较手术治疗组低,手术治疗组的一期通畅率较腔内治疗组高,而二期通畅率两组差异无统计学意义。Objective To analyze the medium-and long-term results of open surgery and endovascular therapy for aortoiliac occlusive disease(AIOD).Methods The clinical data of 92 patients with TASCⅡC/D AIOD admitted to the First Affiliated Hospital of China Medical University from January 2010 to January 2020 were analyzed retrospectively.They were divided into open surgery group(38 cases)and endovascular therapy group(54 cases)according to the surgical methods.The perioperative results and medium-and long-term efficacy of the two groups were compared.The Kaplan-Meier method and log-rank test were used to compare the patency rates and the cumulative survival rates of patients between the two groups.Results 90 patients achieved technical success,with a technical success rate of 97.8%,and 85 patients(92.4%)had improved symptoms.8 patients(8.7%)had the perioperative complications,and the complication rate in the open surgery group was higher than that in the endovascular therapy group(15.8%vs 3.7%,χ^(2)=4.103,P=0.043).89 patients(96.7%)were followed up with an average follow-up time of(92.67±21.74)months.The primary patency rate in the open surgery group at 5 and 10 years was higher than that in the endovascular therapy group at the same period(5 years:91.5%vs 85.2%;10 years:78.4%vs 77.9%),with a statistically significant difference(P=0.040),while the secondary patency rate in the two groups had no statistically significant difference(P=0.102).There were no significant differences in postoperative recurrence rate,restenosis rate,limb salvage rate,and survival rate between the two groups(all P>0.05).Conclusion The incidence of complications in the endovascular therapy group is lower than that in the open surgery group.The primary patency rate in the open surgery group is higher than that in the endovascular therapy group,while there is no difference in the secondary patency rate between the two groups.

关 键 词：主髂动脉闭塞症 开放手术 腔内治疗 中远期疗效 

分 类 号：R654.3[医药卫生—外科学]