中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
6期
459-462
,共4页
龚昆梅%肖乐%王昆华%张勇学%欧阳一鸣%凌平%黄映光%李临海%龙亚新%张剑%朱宇
龔昆梅%肖樂%王昆華%張勇學%歐暘一鳴%凌平%黃映光%李臨海%龍亞新%張劍%硃宇
공곤매%초악%왕곤화%장용학%구양일명%릉평%황영광%리림해%룡아신%장검%주우
动脉硬化,闭塞性%血管外科手术%下肢%血管重建
動脈硬化,閉塞性%血管外科手術%下肢%血管重建
동맥경화,폐새성%혈관외과수술%하지%혈관중건
Arteriosclerosis obliterans%Vascular surgical procedures%Lower extremity%Revascularization
目的 探讨传统外科手术、血管腔内治疗和杂交手术在下肢动脉硬化性闭塞症血管重建中的应用.方法 回顾性分析1998年1月至2008年12月接受血管重建手术的197例下肢动脉硬化性闭塞症患者临床资料,其中外科手术77例,血管腔内治疗82例,杂交手术38例.探讨3种血管重建方法的适应证、治疗效果、并发症及围手术期死亡率.结果 外科手术成功率97.4%(75/77),腔内治疗90.24%(74/82),杂交手术81.58%(31/38).随访2～112个月,平均随访46个月,随诊率71%(164/197).远期通畅率在主髂和股腘动脉中外科手术(57%和51%)高丁腔内治疗(48%和42%),但差异无统计学意义;远期通畅率在多节段病变和动脉狭窄并血栓形成中杂交手术(54%、26%、28%)明显高于其他方法(48%、23%).并发症在主髂和股腘动脉中外科手术(31%、12%)明显高于血管腔内治疗(31%、11%),在多节段病变(36%)明显高于腔内治疗和杂交手术(12%、15%).外科手术对于主髂和多节段动脉病变的围手术期死亡率分别为1.5%、2.0%,其他部位病变为0%;血管腔内治疗和杂交手术均为0%.结论 对于主髂和股腘动脉,外科于术是长段闭塞性病变、血管腔内治疗是短段非闭塞性病变的首选.杂交手术对多节段病变和动脉狭窄并血栓形成更具优势.对于膝下病变,血管腔内治疗能取得较好疗效,但远期通畅率不佳.
目的 探討傳統外科手術、血管腔內治療和雜交手術在下肢動脈硬化性閉塞癥血管重建中的應用.方法 迴顧性分析1998年1月至2008年12月接受血管重建手術的197例下肢動脈硬化性閉塞癥患者臨床資料,其中外科手術77例,血管腔內治療82例,雜交手術38例.探討3種血管重建方法的適應證、治療效果、併髮癥及圍手術期死亡率.結果 外科手術成功率97.4%(75/77),腔內治療90.24%(74/82),雜交手術81.58%(31/38).隨訪2～112箇月,平均隨訪46箇月,隨診率71%(164/197).遠期通暢率在主髂和股腘動脈中外科手術(57%和51%)高丁腔內治療(48%和42%),但差異無統計學意義;遠期通暢率在多節段病變和動脈狹窄併血栓形成中雜交手術(54%、26%、28%)明顯高于其他方法(48%、23%).併髮癥在主髂和股腘動脈中外科手術(31%、12%)明顯高于血管腔內治療(31%、11%),在多節段病變(36%)明顯高于腔內治療和雜交手術(12%、15%).外科手術對于主髂和多節段動脈病變的圍手術期死亡率分彆為1.5%、2.0%,其他部位病變為0%;血管腔內治療和雜交手術均為0%.結論 對于主髂和股腘動脈,外科于術是長段閉塞性病變、血管腔內治療是短段非閉塞性病變的首選.雜交手術對多節段病變和動脈狹窄併血栓形成更具優勢.對于膝下病變,血管腔內治療能取得較好療效,但遠期通暢率不佳.
목적 탐토전통외과수술、혈관강내치료화잡교수술재하지동맥경화성폐새증혈관중건중적응용.방법 회고성분석1998년1월지2008년12월접수혈관중건수술적197례하지동맥경화성폐새증환자림상자료,기중외과수술77례,혈관강내치료82례,잡교수술38례.탐토3충혈관중건방법적괄응증、치료효과、병발증급위수술기사망솔.결과 외과수술성공솔97.4%(75/77),강내치료90.24%(74/82),잡교수술81.58%(31/38).수방2～112개월,평균수방46개월,수진솔71%(164/197).원기통창솔재주가화고객동맥중외과수술(57%화51%)고정강내치료(48%화42%),단차이무통계학의의;원기통창솔재다절단병변화동맥협착병혈전형성중잡교수술(54%、26%、28%)명현고우기타방법(48%、23%).병발증재주가화고객동맥중외과수술(31%、12%)명현고우혈관강내치료(31%、11%),재다절단병변(36%)명현고우강내치료화잡교수술(12%、15%).외과수술대우주가화다절단동맥병변적위수술기사망솔분별위1.5%、2.0%,기타부위병변위0%;혈관강내치료화잡교수술균위0%.결론 대우주가화고객동맥,외과우술시장단폐새성병변、혈관강내치료시단단비폐새성병변적수선.잡교수술대다절단병변화동맥협착병혈전형성경구우세.대우슬하병변,혈관강내치료능취득교호료효,단원기통창솔불가.
Objective To evaluate traditional surgical treatment, intraluminal strategy and hybrid operation on revascularization of atherosclerosis obliterans (ASO) of the lower extremity. Methods Clinical data of 197 ASO cases receiving revascularization from January, 1998 to December, 2008 were retrospectively analyzed. Seventy-seven cases underwent surgical treatment, 82 cases received intraluminal therapy, and 38 cases were treated by hybrid operation. The indications, clinical effect, complication and perioperational mortality of these three strategies were evaluated. Results 71% patients (164 cases) were followed up from 2 to 112 months. Surgical and intraluminal method had no statistical difference on long-term patency of aortic-iliac and femoral-popliteal artery (57% vs. 51%;48% vs. 42%). Hybrid procedure led to higher patency on multi-level lesion and concurrent thrombosis. The complications after surgery was higher than intraluminal on aortic- iliac and femoral-popliteal artery (31% vs. 12%;31% vs. 11%), and higher than intraluminal and hybrid on multi-level lesion (36% vs. 12% vs. 15%). The perioperative mortality of surgical group was 1.5% and 2.0% on aortic-iliac and multilevel lesion and 0% on other site;and that of intraluminal and hybrid procedure was 0%. Conclusion For aortic-iliac and femoral-popliteal artery revascularization, surgery was preferred in cases of long occlusive lesion and intervention was preferred for cases with short non-occlusive lesion. Hybrid procedure was the best for multi-level and concurrent thrombosis.
