中国临床新医学
中國臨床新醫學
중국림상신의학
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
2013年
10期
982-985
,共4页
下肢严重缺血%血栓闭塞性脉管炎%动脉硬化闭塞症%静脉动脉化
下肢嚴重缺血%血栓閉塞性脈管炎%動脈硬化閉塞癥%靜脈動脈化
하지엄중결혈%혈전폐새성맥관염%동맥경화폐새증%정맥동맥화
Critical limb ischemia(CLI)%Thromboangiitis obliterans(TAO)%Artherosclerosis obliter-ans( ASO)%Venous arterialization
目的：探讨静脉动脉化手术治疗下肢严重缺血症（ CLI ）的临床应用价值。方法回顾性分析2000-01～2011-12行静脉动脉化手术治疗91例患者的临床资料，其中血栓闭塞性脉管炎70例，动脉硬化闭塞症21例。术前踝/肱指数（ABI）0～4.9（平均3.5）。手术采用高位深组30例，低位深组32例，浅组29例（其中双向血流组22例，直接转流组7例）。结果手术成功率达100％。随访6～60个月，77例患者恢复正常生活，无静息痛存在，间歇性跛行消失或无痛行走距离大于500 m。深组4例患者在术后1年出现移植物闭塞，行截肢术。随访期间，10例患者彩超检查出现移植物闭塞，但无临床症状。总救肢率为95.6％（87/91）；有效率为84.6％（77/91）；移植物长期通.率为84.6％（77/91）。结论静脉动脉化是应用于下肢动脉广泛性闭塞，远端无良好流出道而无法进行常规动脉旁路重建，肢体濒临坏死患者的手术方法，是一种非常规的救肢术式，如适应证选择恰当，手术操作规范，可取得良好疗效。
目的：探討靜脈動脈化手術治療下肢嚴重缺血癥（ CLI ）的臨床應用價值。方法迴顧性分析2000-01～2011-12行靜脈動脈化手術治療91例患者的臨床資料，其中血栓閉塞性脈管炎70例，動脈硬化閉塞癥21例。術前踝/肱指數（ABI）0～4.9（平均3.5）。手術採用高位深組30例，低位深組32例，淺組29例（其中雙嚮血流組22例，直接轉流組7例）。結果手術成功率達100％。隨訪6～60箇月，77例患者恢複正常生活，無靜息痛存在，間歇性跛行消失或無痛行走距離大于500 m。深組4例患者在術後1年齣現移植物閉塞，行截肢術。隨訪期間，10例患者綵超檢查齣現移植物閉塞，但無臨床癥狀。總救肢率為95.6％（87/91）；有效率為84.6％（77/91）；移植物長期通.率為84.6％（77/91）。結論靜脈動脈化是應用于下肢動脈廣汎性閉塞，遠耑無良好流齣道而無法進行常規動脈徬路重建，肢體瀕臨壞死患者的手術方法，是一種非常規的救肢術式，如適應證選擇恰噹，手術操作規範，可取得良好療效。
목적：탐토정맥동맥화수술치료하지엄중결혈증（ CLI ）적림상응용개치。방법회고성분석2000-01～2011-12행정맥동맥화수술치료91례환자적림상자료，기중혈전폐새성맥관염70례，동맥경화폐새증21례。술전과/굉지수（ABI）0～4.9（평균3.5）。수술채용고위심조30례，저위심조32례，천조29례（기중쌍향혈류조22례，직접전류조7례）。결과수술성공솔체100％。수방6～60개월，77례환자회복정상생활，무정식통존재，간헐성파행소실혹무통행주거리대우500 m。심조4례환자재술후1년출현이식물폐새，행절지술。수방기간，10례환자채초검사출현이식물폐새，단무림상증상。총구지솔위95.6％（87/91）；유효솔위84.6％（77/91）；이식물장기통.솔위84.6％（77/91）。결론정맥동맥화시응용우하지동맥엄범성폐새，원단무량호류출도이무법진행상규동맥방로중건，지체빈림배사환자적수술방법，시일충비상규적구지술식，여괄응증선택흡당，수술조작규범，가취득량호료효。
Objective To assess the clinical effectiveness of venous arterialization in the treatment of pa-tients with critical limb ischemia(CLI).Methods From January 2000 to December 2011,91 patients with CLI,in-cluding 70 cases with thromboangiitis obliterans and 21 artherosclerosis obliterans ,underwent venous arterializations . Ankle-brachial index(ABI) was 0~4.9(average 3.5) before operation.According to the different levels of the arteri-al occlusion ,3 kinds of venous arterialization were performed:high deep venous arterialization group ( n=30 ):rever-sal produced between the common or superficial femoral artery and superficial vein ;low deep venous arterialization group(n=32):reversal produced the popliteal artery and the tibiaperoneal venous trunk ;superficial venous arterial-ization group(n=29):reversal produced between the femoral or popliteal artery and the distal potion of the long sa -phenous vein.Results The technical success rate was 100%.All cases were followed up for 6~60 months,and 77 cases of them achieved satisfied results with disappearance of rest pain and absence of intermittent claudication or claudication distance >500 meters.In high deep venous arterializations group ,4 cases replapsed because of graft oc-clusion at 12 months after procedure and then underwent amputation .During the follow-up period,graft occlustion without recurrent symptom was observed in 10 patients.Overall limb salvage rate,effective rate and secondary graft patency rate was 95.6%,84.6%,84.6%,respectively.Conclusion When patients with CLI cannot be treated by any conventional treatment and require amputate ,venous arterialization may be considered as unconventionality alter-native to save limbs if indivcation was selected carefully and procedure was operated standardly .
