大隐静脉动脉化手术与腔内手术治疗血栓闭塞性脉管炎疗效比较  

Comparison of the efficacy of great saphenous vein arterialization surgery and endovascular surgery in the treatment of thromboangiitis obliterans

作　　者：再英·叶尔宝 狄涛 李虎[1] 田野[1] ZAIYING·Yeerbao;DI Tao;LI Hu;TIAN Ye(Department of Vascular and Thyroid Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院血管甲状腺外科,新疆乌鲁木齐830011

出　　处：《中国普通外科杂志》2024年第6期935-942,共8页China Journal of General Surgery

摘　　要：背景与目的:血栓闭塞性脉管炎(TAO)是发生在末梢的中小动静脉的器质性疾病,病因未知,治疗手段有限。随着医疗科技的进步,目前常用方法以大隐静脉动脉化手术与腔内手术为主,但两种术式疗效的优劣尚未形成共识。因此,本研究对比大隐静脉动脉化手术与腔内手术在治疗TAO的临床疗效,以期为临床治疗提供参考。方法:回顾性分析2015年1月─2023年4月183例因TAO就诊于新疆医科大学第一附属医院的患者临床与随访资料,其中行大隐静脉动脉化患者40例(大隐静脉动脉化组),行腔内治疗患者143例(腔内治疗组)。根据年龄(±5岁)、病变段TASC分级将两组患者进行1∶1匹配,匹配后两组各36例,均为男性。对比两组患者的相关临床指标。结果:匹配后两组患者的基线资料差异均无统计学意义(均P>0.05)。大隐静脉动脉化组术后通畅率和踝肱指数优于腔内治疗组,二次手术干预率低于腔内治疗组(均P<0.05)。腔内治疗组在术后疼痛视觉模拟评分、间歇性跛行以及住院时间方面优于大隐静脉动脉化组(均P<0.05)。两组在术后足部感觉冰凉/麻木、坏疽的情况、截肢率和术后感染情况方面没有明显差异(均P>0.05)。Kaplan-Meier曲线分析结果显示大隐静脉动脉化组的长期预后优于腔内治疗组(P<0.05)。结论:相较于腔内治疗,大隐静脉动脉化手术治疗TAO效果更佳,可以提高通畅率和降低二次手术干预率,而且费用较低,中、远期疗效更好。如果患者经济状况存在困难,可以考虑大隐静脉动脉化手术,术后可提高中、远期疗效。腔内治疗相较于大隐静脉动脉化手术,术后近期临床疗效较好,患者静息痛等主观感觉改善情况要优于大隐静脉动脉化组,但是长期预后情况不如大隐静脉动脉化术后。因此,在没有合适的血管移植物的情况下,腔内手术也是一种可选方案,可以减轻术后疼痛感,提高患者的生活�Background and Aims:Thromboangiitis obliterans(TAO)is an organic disease affecting small and medium-sized arteries and veins in the extremities.Its cause is unknown,and treatment options are limited.With advances in medical technology,the most commonly used methods are great saphenous vein arterialization surgery and endovascular surgery.However,there is no consensus on the superiority of these two procedures.Therefore,this study was performed to compare the clinical efficacy of great saphenous vein arterialization surgery and endovascular surgery in treating TAO,aiming to provide a reference for clinical treatment.Methods:The clinical and follow-up data of 183 patients diagnosed with TAO at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to April 2023 were retrospectively analyzed.Among them,40 patients underwent great saphenous vein arterialization(great saphenous vein arterialization group),and 143 patients underwent endovascular treatment(endovascular treatment group).The patients were matched 1:1 based on age(±5 years)and TASC classification of the lesion segment,resulting in 36 pairs of patients,all male.Relevant clinical indicators were compared between the two groups.Results:There were no statistically significant differences in the baseline data between the two groups after matching(all P>0.05).The great saphenous vein arterialization group showed better postoperative patency rates and ankle-brachial index than the endovascular treatment group and a lower rate of secondary surgical interventions(all P<0.05).The endovascular treatment group had better outcomes regarding postoperative pain visual analogue scale scores,intermittent claudication,and length of hospital stay,than the great saphenous vein arterialization group(all P<0.05).The two groups had no significant differences regarding postoperative foot coldness/numbness,gangrene,amputation rates,and postoperative infection(all P>0.05).Kaplan-Meier curve analysis indicated that the long-term prognosis was better in the g

关 键 词：闭塞性血栓性脉管炎 大隐静脉动脉化 血管内操作 

分 类 号：R654.3[医药卫生—外科学]