CAJ | 학술논문

目的：总结本院股浅动脉支架与股-腘动脉人工血管旁路移植术治疗股浅动脉闭塞病变的效果。方法以本院2008年1月至2010年12月接受经皮腔内血管成形术+支架置入术（PTA/S）或股-腘动脉人工血管旁路移植术治疗股浅动脉闭塞病变的84个病例（84条下肢）作为研究对象进行研究。记录病人的年龄、术前合并症、术后并发症、TASC分级、住院时间、远端流出道情况、支架或人工血管再狭窄及闭塞情况、有无截肢，以及死亡率等。结果血管腔内治疗（PTA/S）组44条股浅动脉均接受了经皮腔内血管成形术+支架置入术，旁路组40条肢体接受了股腘动脉人工血管旁路移植术；病人平均年龄分别为70.3岁（腔内组）和65.1岁（旁路组）（P＜0.05）；平均住院时间分别是7.5天和14.3天（P＜0.05），接受人工血管旁路移植术的患者主要是TASC C、D级长段闭塞病变；接受血管腔内技术治疗的患者主要是TASC A、B级病变，少数TASC C、D级的病人因心肺等重要器官功能较差，也接受了血管腔内技术治疗；两组病人围手术期死亡率差别没有显著性意义；而术后3年死亡率分别是5.2%（支架组）和2.6%（旁路组）（P＜0.05）。切口感染率旁路组（3%）高于支架组（0%）（P＜0.05）；3年再狭窄或闭塞发生率旁路组（52%）低于支架组（61%）（P＜0.05）。结论人工血管动脉旁路移植术能够获得较高的远期通畅率，但住院时间长，个别病人发生切口感染是其缺点；股浅动脉球囊扩张成型+支架植入术有手术创伤小，病人恢复快，住院时间短的优点，但是其远期通畅率有待进一步提高。
목적：총결본원고천동맥지가여고-객동맥인공혈관방로이식술치료고천동맥폐새병변적효과。방법이본원2008년1월지2010년12월접수경피강내혈관성형술+지가치입술（PTA/S）혹고-객동맥인공혈관방로이식술치료고천동맥폐새병변적84개병례（84조하지）작위연구대상진행연구。기록병인적년령、술전합병증、술후병발증、TASC분급、주원시간、원단류출도정황、지가혹인공혈관재협착급폐새정황、유무절지，이급사망솔등。결과혈관강내치료（PTA/S）조44조고천동맥균접수료경피강내혈관성형술+지가치입술，방로조40조지체접수료고객동맥인공혈관방로이식술；병인평균년령분별위70.3세（강내조）화65.1세（방로조）（P＜0.05）；평균주원시간분별시7.5천화14.3천（P＜0.05），접수인공혈관방로이식술적환자주요시TASC C、D급장단폐새병변；접수혈관강내기술치료적환자주요시TASC A、B급병변，소수TASC C、D급적병인인심폐등중요기관공능교차，야접수료혈관강내기술치료；량조병인위수술기사망솔차별몰유현저성의의；이술후3년사망솔분별시5.2%（지가조）화2.6%（방로조）（P＜0.05）。절구감염솔방로조（3%）고우지가조（0%）（P＜0.05）；3년재협착혹폐새발생솔방로조（52%）저우지가조（61%）（P＜0.05）。결론인공혈관동맥방로이식술능구획득교고적원기통창솔，단주원시간장，개별병인발생절구감염시기결점；고천동맥구낭확장성형+지가식입술유수술창상소，병인회복쾌，주원시간단적우점，단시기원기통창솔유대진일보제고。
Objective To summarize the effects of endovascular intervention and artificial graft by-pass for the patients with occlusive superficial artery disease in our hospital. Methods The clinical data on 84 patients with superficial artery occlusive disease who underwent endovascular or artificial graft by-pass were retrospectively reviewed from 2008.01 and 2010.12. The age, accompanied diseases, postoperative complications, TASC grading,mean hospitalize stay, condition of outflow tract, restenosis,amputation and mortality were recorded and analysed. Results 44 limbs underwent percutaneous transluminal angioplasty and stent(PTA/S)and 40 limbs did femoropopliteal artiifcial graft by-pass. The average age was respectively 70.3 years old and 65.1 years old in the PTA/S group and in by-passing group(P<0.05).The mean hospitalize stay was respectively 7.5 days and 14.3 days(P< 0.05).The patients underwent femoropopliteal artiifcial graft by-pass mostly suffered with TASC C lesions or TASC D lesions. There were no obvious difference on perioperative mortality of the patients between the PTA/S group and the by-passing group.The mortality of 3 years after procedure was respectively 5.2%in the PTA/S group and 2.6%in the bypassing group(P<0.05). Rate of postoperative infection in the bypassing group is higher than those of in the PTA/S group(P<0.05). Restenosis rate of 3 years after operation in the bypassing group(52%)is lower than those of in the PTA/S group(61%)(P < 0.05). Conclusion Artificial graft by-pass for the treatment of the patients with occlusive superifcial artery disease have an advantage of better longterm patency,but do dis advantages of long hospitalized stay and high postoperative incision infection.The femoral-popliteal artery percutaneous balloon catheter technique and stent have an advantage of slighter trauma,short hospitalized stay and low postoperative incision infection.But its secondary patency need to be improved.