血管旁路移植术治疗下肢动脉广泛闭塞性疾病的疗效分析  

Efficacy of vascular bypass grafting in treating multilevel lower extremity arterial occlusive disease

作　　者：吴伟滨 王冕[1] 李梓伦[1] 姚陈[1] 武日东[1] 宁俊杰 刘春良 常光其[1] Wu Weibin;Wang Mian;Li Zilun;Yao Chen;Wu Ridong;Ning Junjie;Liu Chunliang;Chang Guangqi(National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases,Division of Vascular Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou510080,China)

机构地区：[1]血管疾病诊治技术国家地方(广东)联合工程实验室、中山大学附属第一医院血管外科,广州510080

出　　处：《中华血管外科杂志》2024年第6期371-377,共7页Chinese Journal of Vascular Surgery

基　　金：国家自然科学基金(82200544)。

摘　　要：目的探讨血管旁路移植术在治疗下肢动脉广泛闭塞性疾病的中期疗效。方法本研究为回顾性纵向研究。收集2014年1月至2023年12月中山大学附属第一医院血管外科收治的93例下肢动脉广泛闭塞性病变并接受血管旁路移植术患者的临床资料,其中男性79例,女性14例;年龄(60.7±15.1)岁。手术指征为间歇性跛行(22例,23.7%)和慢性肢体威胁性缺血(71例,76.3%)。观察和评估患者的病例特点、手术方式和随访情况。采用Cox回归模型分析血管旁路移植手术患者预后的影响因素;采用Kaplan-Meier法绘制生存曲线,组间比较采用Log-rank检验。结果93例患者均完成手术,技术成功率为100%。其中旁路血管采用人工血管59例(63.5%),自体静脉23例(24.7%),人工血管桥接自体静脉11例(11.8%);远端吻合口位于膝下动脉28例(30.1%),位于膝上动脉65例(69.9%)。围手术期死亡4例,其中3例为尿毒症引起的多器官功能衰竭,1例为急性心肌梗死。患者术后踝肱指数较术前升高,差异具有统计学意义(U=2.000,P<0.001)。中位随访时间为34(12,53)个月,1例失访。术后6、12、24和60个月的一期通畅率分别为72.5%、67.3%、64.9%和58.3%;无截肢生存率分别为79.8%、76.1%、75.8%和47.2%;肢体保留率分别为78.8%、76.1%、75.8%和72.9%;总生存率分别为85.9%、80.7%、76.8%和66.3%。Cox回归分析提示流出道>1条是维持旁路通畅的重要因素(HR=0.340,95%CI:0.139~0.829,P=0.018);冠心病(HR=4.029,95%CI:1.487~10.916,P=0.006)、肾功能不全(HR=4.825,95%CI:1.718~13.551,P=0.003)、人工血管(HR=3.666,95%CI:1.355~9.920,P=0.011)及流出道>1条(HR=0.405,95%CI:0.188~0.876,P=0.022)与旁路移植术后无截肢生存率的关系密切;而脑血管疾病(HR=3.337,95%CI:1.485~7.500,P=0.004)、高血压(HR=2.622,95%CI:1.206~5.704,P=0.015)、糖尿病(HR=2.622,95%CI:1.206~5.704,P=0.015)及肾功能不全(HR=5.945,95%CI:2.737~12.913,P<0.001)与旁路移植术后患者的全因死亡率密切相关ObjectiveTo explore the mid-term efficacy of vascular bypass grafting in treating multilevel arteriosclerosis obliterans of lower extremities.MethodsIn this longitudinal study,clinical data of 93 patients with arteriosclerosis obliterans of lower extremities who had undergone bypass grafting at the Division of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University between January 2014 and December 2023 were collected.Among the 93 patients,79 are males and 14 are females,with an age of(60.7±15.1)years.Their indications for surgery were intermittent claudication(22 cases,23.7%)and chronic limb-threatening ischemia(71 cases,76.3%).Case characteristics,surgical methods,and follow-up outcomes were observed and examined.The Cox regression model was used to analyze the factors influencing prognosis in cases undergoing vascular bypass grafting.The Kaplan-Meier method was utilized to estimate survival curves,and the Log-rank test was adopted for comparison between groups.ResultsThe technical success rate of bypass grafting was 100%among all 93 cases,including 59(63.5%)using artificial vascular graft,23(24.7%)using autologous vein,and 11(11.8%)using a combination of artificial vascular graft with the autologous vein.The distal anastomosis was located in the below-knee artery in 28 cases(30.1%)and in the above-knee artery in 65 cases(69.9%).There were 4 perioperative deaths,of which 3 were due to multi-organ failure caused by uremia,and 1 was due to acute myocardial infarction.The ankle-brachial index of cases after surgery was higher than that before surgery,and there were statistically significant differences(U=2.000,P<0.001).The median follow-up duration was 34 months(12-53 months),with 1 case lost to follow-up.The postoperative primary patency rates at the 6,12,24,and 60 months were 72.5%,67.3%,64.9%,and 58.3%respectively;the amputation-free survival rates were 79.8%,76.1%,75.8%,and 47.2%respectively;the limb retention rates were 78.8%,76.1%,75.8%,and 72.9%respectively;and the overall survival rates w

关 键 词：下肢动脉闭塞性疾病 血管旁路移植术 人工血管 自体血管 

分 类 号：R54[医药卫生—心血管疾病]