腔内和血管旁路手术治疗锁骨下动脉闭塞的疗效分析  

Effect evaluation of endovascular intervention and bypass therapy for subclavian artery occlusion

作　　者：王飞[1] 王辉[1] 郭建明[1] 高喜翔[1] 佟铸[1] 崔世军[1] 谷涌泉[1] 郭连瑞[1] WANG Fei;WANG Hui;GUO Jianming;GAO Xixiang;TONG Zhu;CUI Shijun;GU Yongquan;GUO Lianrui(Department of Vascular Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管外科,北京100053

出　　处：《中国现代手术学杂志》2024年第1期37-41,共5页Chinese Journal of Modern Operative Surgery

基　　金：首都医科大学宣武医院国自然青年培育项目(QNPY2021007)。

摘　　要：目的 探讨腔内手术和血管旁路手术治疗锁骨下动脉闭塞的疗效。方法 回顾性分析2020年1月至2022年12月我科收治的69例锁骨下动脉闭塞患者的临床资料,其中左侧病变56例,右侧病变13例;病变位于起始部65例,中段4例。结果 59例患者成功接受手术治疗,术中均无并发症及死亡发生。行旁路手术19例(颈总动脉-锁骨下动脉旁路9例,腋-腋动脉旁路10例),术后出现淋巴瘘及消化道出血各1例。腔内治疗40例(经股动脉穿刺顺行开通20例,联合肱动脉穿刺逆向开通20例),术后出现急性脑梗死及急性心肌梗死各1例,均经保守治疗后好转,左侧肱动脉血栓形成1例,急诊行肱动脉切开取栓术。其余患者术后30 d内均无并发症及死亡发生。随访3~32个月,中位随访时间14.8个月,腔内治疗和旁路手术患者间累积通畅率比较无统计学差异。结论 腔内手术和血管旁路手术均可有效治疗锁骨下动脉闭塞,需要根据患者的具体情况选择合适的手术方式。Objective To explore the effect of endovascular intervention and vascular bypass in the treatment of subclavian artery occlusion(SAO).Methods The clinical data of 69 SAO patients admitted to our hospital from January 2020 to December 2022 were analyzed retrospectively,including 56 cases with left lateral lesion and 13 cases with right lateral lesion.The involved lesion was located in the initial part in 65 cases and in the middle part in 4 cases.Results Of the 69 patients,59 were treated by surgery successfully without intra-operative complication and death.Bypass surgery was performed in 19 cases,including 9 of common carotid-subclavian artery bypass and 10 of axillary-axillary artery bypass.There was lymphatic fistula and gastrointestinal bleeding in one case respectively after the surgery in the bypass cases.Endovascular inter-vention was performed in 40 cases.Of which,20 cases were opened by anterograde femoral artery approach,and 20 cases were by retrograde brachial artery approach following failed femoral artery approach.Acute cere-bral infarction was found in one case,acute myocardial infarction was in one case after the operation,and both were improved after conservative treatment,and left brachial artery thrombosis was in one case and treated by emergency brachial artery thrombectomy in the endovascular intervention cases.No complication or death was found in other patients during 30 days after the operation.All cases were followed up for 3 to 32 months,with a median time of 14.8 months.There was no significant statistical difference in the cumulative patency rate between the patients with endovascular intervention and bypass surgery.Conclusions Both endovascular therapy and bypass surgery can achieve good effect for SAO;The appropriate surgical methods would be selected according to the specific conditions of patients.

关 键 词：锁骨下动脉闭塞 腔内治疗 血管旁路 

分 类 号：R654.3[医药卫生—外科学]