中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
4期
306-309
,共4页
马杰%马韬%王刃%赵旭%李悦萌
馬傑%馬韜%王刃%趙旭%李悅萌
마걸%마도%왕인%조욱%리열맹
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
動脈硬化,閉塞性%髂動脈%股動脈血管外科手術%血管假體植入
동맥경화,폐새성%가동맥%고동맥혈관외과수술%혈관가체식입
Arteriosclerosis,obliterans%Iliacartery%Femoral artery%Vascular surgical procedures%Blood vessel prosthesis implantation
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.
目的 評價健側髂外動脈-患側腘動脈人工血管移植交扠轉流術(EIP)和健側股-患側股深動脈交扠轉流術(FDF)治療髂股動脈長段硬化閉塞癥的療效.方法 本組85例患者為1995年7月至2009年12月接受治療的髂股動脈長段硬化閉塞癥患者.其中男性61例,女性24例；年齡64 ～91歲,平均年齡75歲.按Fontaine分期,Ⅱh～Ⅲ期62例(72.9％),Ⅳ期23例(27.1％).根據患肢股深動脈及膝上、下腘動脈顯影狀況,分彆採用EIP(49例)、FDF(36例)進行治療.比較兩組患者轉流術後患肢潰瘍、截趾創麵愈閤、踝肱指數、患肢血流速度,以及1、3、5年纍積通暢率和3、5年保肢率.結果 圍手術期無死亡及截肢患者.74例(87.1％)穫得隨訪；隨訪2～13年,平均5.7年.FDF組與EIP組術後踝肱指數分彆為0.52±0.11和0.94±0.13(t=-21.88,P=0.000).FDF組與EIP組術後血管多普勒超聲檢測腘動脈血流速度為(32±9)cm/s和(48±4) cm/s(t=16.76,P=0.000),脛前(後)動脈血流速度為(22±7)cm/s和(42±4)cm/s(t=10.50,P =0.00).FDF組與EIP組術後1、3、5年一二期纍積通暢率分彆為87.8％、80.7％、68.4％和88.3％、81.2％、57.4％,術後3、5年保肢率分彆為87.6％、76.7％和88.6％、71.3％,兩組比較差異無統計學意義(P均＞0.05).結論 FDF、EIP這兩種解剖外徬路手術治療單側髂總-股淺動脈硬化閉塞癥安全有效,尤其適宜高危老年患者.
목적 평개건측가외동맥-환측객동맥인공혈관이식교차전류술(EIP)화건측고-환측고심동맥교차전류술(FDF)치료가고동맥장단경화폐새증적료효.방법 본조85례환자위1995년7월지2009년12월접수치료적가고동맥장단경화폐새증환자.기중남성61례,녀성24례；년령64 ～91세,평균년령75세.안Fontaine분기,Ⅱh～Ⅲ기62례(72.9％),Ⅳ기23례(27.1％).근거환지고심동맥급슬상、하객동맥현영상황,분별채용EIP(49례)、FDF(36례)진행치료.비교량조환자전류술후환지궤양、절지창면유합、과굉지수、환지혈류속도,이급1、3、5년루적통창솔화3、5년보지솔.결과 위수술기무사망급절지환자.74례(87.1％)획득수방；수방2～13년,평균5.7년.FDF조여EIP조술후과굉지수분별위0.52±0.11화0.94±0.13(t=-21.88,P=0.000).FDF조여EIP조술후혈관다보륵초성검측객동맥혈류속도위(32±9)cm/s화(48±4) cm/s(t=16.76,P=0.000),경전(후)동맥혈류속도위(22±7)cm/s화(42±4)cm/s(t=10.50,P =0.00).FDF조여EIP조술후1、3、5년일이기루적통창솔분별위87.8％、80.7％、68.4％화88.3％、81.2％、57.4％,술후3、5년보지솔분별위87.6％、76.7％화88.6％、71.3％,량조비교차이무통계학의의(P균＞0.05).결론 FDF、EIP저량충해부외방로수술치료단측가총-고천동맥경화폐새증안전유효,우기괄의고위노년환자.
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.
