紫杉醇药物涂层球囊联合金属裸支架对比单独金属裸支架治疗股浅动脉粥样硬化闭塞症的疗效分析  

Paclitaxel drug-coated balloons combined with bare metal stents vs. bare metal stents for the treatment of superficial femoral atherosclerosis obliterans

作　　者：赵起健 张建彬[2] 赵豪 贺斌 王旭明 马博[2] 陈洁[2] 陈冲 叶志东[2] Zhao Qijian;Zhang Jianbin;Zhao Hao;He Bin;Wang Xuming;Ma Bo;Chen Jie;Chen Chong;Ye Zhidong(Department of Cardiovascular Surgery,Peking University China‐Japan Friendship School of Clinical Medicine,Beijing 100029,China;Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Basic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]北京大学中日友好临床医学院心脏血管外科,北京100029 [2]中日友好医院心脏血管外科,北京100029 [3]中国医学科学院北京协和医院基本外科,北京100005

出　　处：《中华普通外科杂志》2023年第7期500-505,共6页Chinese Journal of General Surgery

基　　金：中央高水平医院临床科研业务费;中日友好医院“菁英计划”人才培育工程(ZRJY2021-QM13)。

摘　　要：目的比较紫杉醇药物涂层球囊联合金属裸支架与单独金属裸支架在治疗股浅动脉粥样硬化闭塞症方面的疗效和安全性。方法回顾性分析2017年1月至2022年8月在中日友好医院心脏血管外科接受联合治疗或单独金属裸支架治疗的80例患者(82条患肢)的临床及随访资料。结果联合治疗组共43例患者(43条患肢),金属裸支架组37例患者(39条患肢)。联合治疗组的平均病变长度较金属裸支架组更长(19.54±7.04 cm比16.25±6.43 cm,P=0.031),36个月主要通畅率高于金属裸支架组,但差异无统计学意义(56.9%比38.5%,P=0.171)。在股浅动脉泛大西洋协作组(Trans-Atlantic Inter-Society Consensus,TASC)和C/D级慢性闭塞性病变亚组分析中,联合治疗组疗效优于金属裸支架组,36个月通畅率分别为57.6%比23.8%(P=0.046),60.2%比31.4%(P=0.028)。两组总体36个月免于临床相关靶血管血运重建率差异无统计学意义(72.6%比66.5%,P=0.706),术后主要不良事件方面差异无统计学意义(P>0.05)。结论紫杉醇涂层球囊联合金属裸支架治疗股浅动脉粥样硬化闭塞症安全有效,并且在TASC C/D以及慢性闭塞性病变中疗效优于金属裸支架。Objective To compare the efficacy and safety of drug-coated balloons(DCB)combined with bare metal stents(BMS)and BMS only for superficial femoral atherosclerosis obliterans.Methods The clinical and follow-up data of 80 patients(82 limbs)who received combined treatment or BMS implantation at Cardiovascular Surgery Department of China Japan Friendship Hospital from Jan 2017 to Aug 2022 were retrospectively analyzed.Results 43 patients(43 limbs)were included in combined treatment group.37 patients(39 limbs)were in BMS only.The average lesion length of combined group was longer than BMS group(19.54±7.04 cm vs.16.25±6.43 cm,P=0.031).The primary patency rate of combined group at 36 months was not statistically different with BMS only group(56.9%vs.38.5%,P=0.171).The subgroup analysis of superficial femoral artery TASC C/D(Trans-Atlantic Inter-Society Consensus)and CTO(chronic total occlusion)lesions indicated that efficacy of the combined group was superior to BMS only group.The patency rates of the combined group compared with the BMS group at 36 months were 57.6%vs.23.8%,P=0.046,60.2%vs.31.4%,P=0.028,respectively.There was no significant difference in the FCD-TLR(free from clinical driven target lesion revascularization)between the two groups at 36 months(72.6%vs.66.5%,P=0.706).There was no significant difference in major adverse events between the two groups(P>0.05).Conclusion Paclitaxel drug-coated balloon combined with bare metal stent is a safe and effective treatment for superficial femoral atherosclerosis obliterans,which is superior to bare metal stent,especially in TASC C/D and chronic total occlusive lesions.

关 键 词：支架 股动脉 动脉粥样硬化 

分 类 号：R654.4[医药卫生—外科学]