下肢动脉硬化闭塞症腔内治疗术后再次手术干预最佳时间窗分析  

作　　者：柴东喆 张华一 陈春伦 何甜 

机构地区：[1]浙江省嘉兴市第二医院,314000

出　　处：《浙江临床医学》2024年第10期1473-1475,共3页Zhejiang Clinical Medical Journal

基　　金：嘉兴市科技局民生科技创新研究项目(2020AD30093)。

摘　　要：目的探讨下肢动脉硬化闭塞症腔内治疗术后再次手术干预最佳时间窗。方法选取2020年9月至2023年6个月施行过球囊扩张(PTA)和(或)架植入术(STENT)的256例下肢动脉硬化闭塞症(ASO)患者中首次术后6个月出现下肢动脉中重度以上狭窄(CTA测量内径/正常内径≤50%)或闭塞的患者33例。根据治疗方式不同分为观察组、对照组A和对照组B,其中观察组8例于术后6个月左右(平均6.5个月)行球囊扩张(PTA)为主的再次手术;对照组A 7例于术后12~28个月(平均20.3个月)行再次手术;对照组B 18例采取药物保守治疗。比较3组患者首次术后12、18、24、30个月的动脉通畅率、手术成功率及手术总费用。结果观察组术后18、24、30个月的动脉通畅率均高于对照组,同对照组B手术成功率相仿,开通靶血管用时短,手术费用低。结论对ASO首次术后出现中重度再狭窄、闭塞患者在术后6个月行再次腔内治疗具有成功率高、动脉中远期通畅率高,是行再次手术干预的最佳时间窗。Objective To investigate the optimal time window for reoperative intervention in endovascular treatment of arteriosclerosis obliterans of lower extremities.Methods A total of 256 patients with lower limb arterial occlusive disease(ASO)who underwent balloon angioplasty(PTA)and/or stent implantation(STENT)from September 2020 to June 2023 were selected as the study subjects.Among them,33 patients experienced moderate to severe stenosis(CTA measured inner diameter/normal inner diameter≤50%)or occlusion of the lower limb arteries 6 months after the first surgery.According to different treatment methods,patients were divided into the intervention group,the control group A,and the control group B.Among them,8 patients in the intervention group underwent reoperation mainly with PTA around 6 months(average 6.5 months)after surgery;18 cases in the control group A were treated with conservative medication.Seven patients in the control group B underwent reoperation between 12~28 months(average 20.3 months)after surgery.The arterial patency rate,surgical success rate,and total surgical cost of the three groups were compared at 12,18,24,and 30 months after the first surgery.Results The arterial patency rate of the intervention group at 18,24,and 30 months after surgery was higher than that of the two control groups,and the success rate of surgery was similar to that of the control group B.The target vessel was opened in a shorter time and the surgical cost was lower.Conclusion For patients with moderate to severe restenosis or occlusion after the first ASO surgery,performing endovascular treatment again 6 months after surgery has a high success rate and a high mid to long term arterial patency rate,making it the best time window for reoperation intervention.

关 键 词：动脉硬化闭塞症 支架内再狭窄、再闭塞 药物洗脱球囊 经皮腔内血管成形术 内膜增生 

分 类 号：R654.3[医药卫生—外科学]