两种非传统解剖外旁路手术治疗髂股动脉长段硬化闭塞症
马杰;马韬;王刃;赵旭;李悦萌
【期刊名称】《中华外科杂志》 【年(卷),期】2012(050)004
【摘要】目的 评价健侧髂外动脉-患侧腘动脉人工血管移植交叉转流术(EIP)和健侧股-患侧股深动脉交叉转流术(FDF)治疗髂股动脉长段硬化闭塞症的疗效.方法 本组85例患者为1995年7月至2009年12月接受治疗的髂股动脉长段硬化闭塞症患者.其中男性61例,女性24例；年龄64 ～91岁,平均年龄75岁.按Fontaine分期,Ⅱh～Ⅲ期62例(72.9％),Ⅳ期23例(27.1％).根据患肢股深动脉及膝上、下腘动脉显影状况,分别采用EIP(49例)、FDF(36例)进行治疗.比较两组患者转流术后患肢溃疡、截趾创面愈合、踝肱指数、患肢血流速度,以及1、3、5年累积通畅率和3、5年保肢率.结果 围手术期无死亡及截肢患者.74例(87.1％)获得随访；随访2～13年,平均5.7年.FDF组与EIP组术后踝肱指数分别为0.52±0.11和0.94±0.13(t=-21.88,P=0.000).FDF组与EIP组术后血管多普勒超声检测腘动脉血流速度为(32±9)cm/s
和(48±4)
cm/s(t=16.76,P=0.000),胫前(后)动脉血流速度为(22±7)cm/s和(42±4)cm/s(t=10.50,P =0.00).FDF组与EIP组术后1、3、5年一二期累积通畅率分别为87.8％、80.7％、68.4％和88.3％、81.2％、57.4％,术后3、5年保肢率分别为87.6％、76.7％和88.6％、71.3％,两组比较差异无统计学意义(P均＞0.05).结论 FDF、EIP这两种解剖外旁路手术治疗单侧髂总-股浅动脉硬化闭塞症安全有效,尤其适宜高危老年患者.%Objective To report and evaluate the clinical results of surgical treatment for longsegment
iliofemoral arteriosclerosis obliterans,including external iliac-popliteal (EIP)
and
femoral-deep
femoral
(FDF)
crossover
bypass
surgeries.Methods From July 1995 to December 2009,85 patients (61male,24 female,aged from 64 to 91 years,mean age 75 years) with comprehensive
unilateral
iliacsuperficial
femoral
arteriosclerosis
obliterans were involved in this research. According to Fontaine classification,the 85 patients could be graded as 62 class Ⅱ b-Ⅲ patients (72.9％),and 23 class Ⅳpatients (27.1％ ).In CT angiography or DSA examinations,the 85 patients were grouped into EIP (n =49 ) and FDF ( n =36 ) surgical groups on the basis of visnalizations in the affected deep femoral,supraknee/infra-knee popliteal arteries. The healing time of ulcers and toe amputation wound,ankle-brachial index,and blood flow velocity in the affected limb together with accumulative patency rates in 1,3 and 5 years and limb salvage rates in 3 and 5 years were analyzcd.Results Nonc of the 85 patients died or had extremity amputated in perioperatively. Seventy-four patients ( 87.1％ ) had been followed up from 2 to 13 years ( mean 5.7 ycars).Postoperative ankle-brachial index of FDF and EIP groups was 0.55 ± 0.11,and 0.94 ± 0.13 ( t =- 21.88,P =0.000).Postoperative velocity of popliteal artery blood flow in FDF and EIP groups was (32±9) crr/s,and (48 ±4) cm/s (t =16.76,P =0.000) ; velocity of anterior or posterior tibial artery was (22 ±7) cm/s,and (42 ±4) cm/s (t =10.50,P
=0.000).The primary and secondary patency rates of FDF and EIP groups were 87.8％ and 88.3％,80.7％ and 81.2％,68.4％ and 57.4％ at 1,3 and 5 years,respectively.Limb salvage rates of FDF and EIP groups were 87.6％ and 88.6％,76.7％ and 71.3％,at 3 and 5 years,respectively. There were no statistically significant differences in 1,3,and 5 years' cumulative secondary patency rate and limb salvage rate between FDF and EIP groups.Conclusions As extra-anatomic bypass surgeries,FDF and EIP are both determined to be alternative procedures for unilateral common iliac-superficial femoral artery occlusive disease,especially suitable for high-risk patients.EIP group patients have better clinical outcomes than those in FDF group. 【总页数】4页(306-309)
【关键词】动脉硬化,闭塞性;髂动脉;股动脉血管外科手术;血管假体植入 【作者】马杰;马韬;王刃;赵旭;李悦萌
【作者单位】116033 大连市中心医院血管外科;第二军医大学附属长海医院血管外科;116033 大连市中心医院血管外科;116033 大连市中心医院血管外科;116033 大连市中心医院血管外科 【正文语种】中文 【中图分类】 【文献来源】
https://www.zhangqiaokeyan.com/academic-journal-cn_chinese-journal-surgery_thesis/0201234836612.html
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两种非传统解剖外旁路手术治疗髂股动脉长段硬化闭塞症
