中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
4期
291-294
,共4页
王克勤%杨宝钟%张望德%苑超%原标%宋盛晗%邢彤%廖传军%李谈%张杨%汪忠镐
王剋勤%楊寶鐘%張望德%苑超%原標%宋盛晗%邢彤%廖傳軍%李談%張楊%汪忠鎬
왕극근%양보종%장망덕%원초%원표%송성함%형동%료전군%리담%장양%왕충호
手术后并发症%人工血管%支架%腔内治疗
手術後併髮癥%人工血管%支架%腔內治療
수술후병발증%인공혈관%지가%강내치료
Postoperative complications%Blood vessel prosthesis%Stents%Endovascular revision
目的 探讨经人工血管径路的血管腔内治疗的安全性与疗效.方法 17例人工血管转流术后患者,16例吻合口狭窄伴有人工血管血栓形成(10例同时有流人道或流出道狭窄),1例仅有流入道狭窄.局麻下,16例(有吻合口狭窄和人工血管血栓形成)在人工血管取栓后行血管腔内治疗;1例直接经皮穿刺人工血管行血管腔内治疗.观察转流血管的通畅情况.结果 13例远端吻合口,1例近端吻合口各置入支架1枚,2例远端吻合口放置支架失败(10例同时行髂动脉、腘动脉、胫后或胫前动脉支架置入或球囊扩张术),1例只行股总动脉支架置入.随访时间为1～35个月,平均为(12±4)个月;2例下肢缺血加重,其中1例出现足部及小腿的坏疽,1周后行膝上截肢术,另1例又行转流术;1例3个月后又出现下肢缺血症状,1例6个月后死于心肌梗死,其他病例血管仍保持通畅.结论 经人工血管径路的血管腔内治疗,创伤小,近期疗效尚可,为处理人工血管转流术后吻合口狭窄、流人道和流出道病变添加了一种方法.
目的 探討經人工血管徑路的血管腔內治療的安全性與療效.方法 17例人工血管轉流術後患者,16例吻閤口狹窄伴有人工血管血栓形成(10例同時有流人道或流齣道狹窄),1例僅有流入道狹窄.跼痳下,16例(有吻閤口狹窄和人工血管血栓形成)在人工血管取栓後行血管腔內治療;1例直接經皮穿刺人工血管行血管腔內治療.觀察轉流血管的通暢情況.結果 13例遠耑吻閤口,1例近耑吻閤口各置入支架1枚,2例遠耑吻閤口放置支架失敗(10例同時行髂動脈、腘動脈、脛後或脛前動脈支架置入或毬囊擴張術),1例隻行股總動脈支架置入.隨訪時間為1～35箇月,平均為(12±4)箇月;2例下肢缺血加重,其中1例齣現足部及小腿的壞疽,1週後行膝上截肢術,另1例又行轉流術;1例3箇月後又齣現下肢缺血癥狀,1例6箇月後死于心肌梗死,其他病例血管仍保持通暢.結論 經人工血管徑路的血管腔內治療,創傷小,近期療效尚可,為處理人工血管轉流術後吻閤口狹窄、流人道和流齣道病變添加瞭一種方法.
목적 탐토경인공혈관경로적혈관강내치료적안전성여료효.방법 17례인공혈관전류술후환자,16례문합구협착반유인공혈관혈전형성(10례동시유류인도혹류출도협착),1례부유류입도협착.국마하,16례(유문합구협착화인공혈관혈전형성)재인공혈관취전후행혈관강내치료;1례직접경피천자인공혈관행혈관강내치료.관찰전류혈관적통창정황.결과 13례원단문합구,1례근단문합구각치입지가1매,2례원단문합구방치지가실패(10례동시행가동맥、객동맥、경후혹경전동맥지가치입혹구낭확장술),1례지행고총동맥지가치입.수방시간위1～35개월,평균위(12±4)개월;2례하지결혈가중,기중1례출현족부급소퇴적배저,1주후행슬상절지술,령1례우행전류술;1례3개월후우출현하지결혈증상,1례6개월후사우심기경사,기타병례혈관잉보지통창.결론 경인공혈관경로적혈관강내치료,창상소,근기료효상가,위처리인공혈관전류술후문합구협착、류인도화류출도병변첨가료일충방법.
Objective To evaluate the safety and efficacy of endovascular intervention to revise peripheral bypass problems through prosthetic approach.Methods Among 17 cases undergoing graft bypass anastomotic stenosis and graft thrombosis was identifled in 16 cases(inflow or outflow obstructive lesions in 10),inflow obstructive lessions in 1(without anastomotic and graft thrombosis).All revision procedures were taken under local anesthesia,16 patients were treated by means of surgical thrombectomy followed by endovascular intervention through prosthesis itself in addition to one who had no thrombectomy.The graft patency and clinical outcome were observed.Resuits Thirteen stents were implanted in 13patients with distal anastomotic stenosis and 1 with proximal anastomotic stenosis including 10 stentings/PTAs in iliac popliteal,posterior tibial or anterior tibial arteries.One stent was implanted in 1 patient with common femoral stenosis.Stenting were not used(abandoned)in 2 patients,of which one underwent a foot amputation and calf gangrene occurred a week later,and the other had a redo of grafting.Follow-up time is 1-35 months.with an average of 12±4 months.One had a below-knee amputation two months after intervention,the other had symptoms recurred and treated with a redo 3 months afterwards.the third died of myocardial infarction six months later.Grafts remained patent in the rest 13 patients at follow-up.Conclusions Endovascular intervention through prosthesis is a safe and effective method,which offers an alternative means to treat anastomotic stenosis.inflow or outflow obstructive lesions.
