中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2012年
11期
871-875
,共5页
动脉硬化%腔内治疗%肢体挽救%缺血
動脈硬化%腔內治療%肢體輓救%缺血
동맥경화%강내치료%지체만구%결혈
Arteriosclerosis%Endovascular procedures%Limb salvage%Ischemia
目的 观察应用动脉供血区域理念实施腔内治疗重建严重肢体缺血(critical limb ischemia,CLI)患者下肢血运的疗效.方法 回顾性分析2006年6月至2012年5月收治的612例单纯膝下动脉病变(below-the-knee,BTK)导致CLI的患者相关临床资料,其中286例(357条肢体)依据动脉供血区域理念直接重建滋养动脉血运(直接组)；326例(455条肢体)通过重建非滋养动脉间接改善病损区血运(间接组).比较分析直接组与间接组的以下终点参数:术后3个月内创面愈合率、免截肢生存率、免大型截肢率以及CLI复发率.结果 平均随访(24±18)个月,直接组较间接组的术后3个月内创面愈合率高(82.4％比66.4％,X2=26.16,P＜0.05)；第4年的免截肢生存率分别为48％±5％及37％±6％(t=3.44,P＜0.05)；第4年的免大型截肢率分别为73％±4％及58％±3％(t=4.61,P＜0.05)；CLI复发率为42％±5％及45％±6％(t=-0.64,P＞0.05).结论 应用动脉供血区域理念经腔内重建CLI患者的下肢血运,可有效提高术后3个月内创面愈合率、4年的免截肢生存率及免大型截肢率.
目的 觀察應用動脈供血區域理唸實施腔內治療重建嚴重肢體缺血(critical limb ischemia,CLI)患者下肢血運的療效.方法 迴顧性分析2006年6月至2012年5月收治的612例單純膝下動脈病變(below-the-knee,BTK)導緻CLI的患者相關臨床資料,其中286例(357條肢體)依據動脈供血區域理唸直接重建滋養動脈血運(直接組)；326例(455條肢體)通過重建非滋養動脈間接改善病損區血運(間接組).比較分析直接組與間接組的以下終點參數:術後3箇月內創麵愈閤率、免截肢生存率、免大型截肢率以及CLI複髮率.結果 平均隨訪(24±18)箇月,直接組較間接組的術後3箇月內創麵愈閤率高(82.4％比66.4％,X2=26.16,P＜0.05)；第4年的免截肢生存率分彆為48％±5％及37％±6％(t=3.44,P＜0.05)；第4年的免大型截肢率分彆為73％±4％及58％±3％(t=4.61,P＜0.05)；CLI複髮率為42％±5％及45％±6％(t=-0.64,P＞0.05).結論 應用動脈供血區域理唸經腔內重建CLI患者的下肢血運,可有效提高術後3箇月內創麵愈閤率、4年的免截肢生存率及免大型截肢率.
목적 관찰응용동맥공혈구역이념실시강내치료중건엄중지체결혈(critical limb ischemia,CLI)환자하지혈운적료효.방법 회고성분석2006년6월지2012년5월수치적612례단순슬하동맥병변(below-the-knee,BTK)도치CLI적환자상관림상자료,기중286례(357조지체)의거동맥공혈구역이념직접중건자양동맥혈운(직접조)；326례(455조지체)통과중건비자양동맥간접개선병손구혈운(간접조).비교분석직접조여간접조적이하종점삼수:술후3개월내창면유합솔、면절지생존솔、면대형절지솔이급CLI복발솔.결과 평균수방(24±18)개월,직접조교간접조적술후3개월내창면유합솔고(82.4％비66.4％,X2=26.16,P＜0.05)；제4년적면절지생존솔분별위48％±5％급37％±6％(t=3.44,P＜0.05)；제4년적면대형절지솔분별위73％±4％급58％±3％(t=4.61,P＜0.05)；CLI복발솔위42％±5％급45％±6％(t=-0.64,P＞0.05).결론 응용동맥공혈구역이념경강내중건CLI환자적하지혈운,가유효제고술후3개월내창면유합솔、4년적면절지생존솔급면대형절지솔.
Objective To evaluate medium-term results in critical limb ischemia (CLI) patients undergoing endovascularly revascularization based on concepts of angiosomes.Methods Clinical data were reviewed on 612 CLI patients who had isolated below-the-knee (BTK)lesions and were treated by endovascular technology from June 2006 to May 2012.Following the angiosome model of perfusion,286 patients (357 limbs)were treated by directly revascularizing the feeding artery.326 patients (455 limbs)were treated by revascularizing non-feeding artery to improve perfusion to ulcer indirectly.Primary endpoints included ulce-healing rate as of 3 months,amputation-free survival( AFS),freedom from major amputation (FFMA) and recurrence rate of CLI.Results During follow-up(mean,24 ± 18 months),ulce-healing rate during 3 months of direct treatment group was obviously higher than that of indirect group (82.4％ vs.66.4％,X2 =26.16,P ＜0.05).The fourth year AFS was 48％ ±5％ vs.37％ ±6％,t =3.44,P ＜0.05,and the fourth year FFMA was 73％ ±4％ vs.58％ ±3％,t =4.61,P ＜0.05.In recurrence rate of CLI,there wasn't significant difference between direct group and indirect group(42％ ±5％ vs.45％ ±6％,t =- 0.64,P ＞ 0.05 ).Conclusions Following the angiosome model of perfusion,direct revascularizing the feeding artery of CLI patients can obviously improve ulcer-healing rate during 3 months,medium-term AFS and FFMA.
