中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2014年
3期
298-302
,共5页
目的 分析主髂动脉闭塞外科治疗的方法和疗效.方法 回顾性分析2004年1月至2012年12月收治的195例患者的资料,根据闭塞的部位不同分为5种类型.Ⅰ型:单髂动脉闭塞,108例(55.4％)；Ⅱ型:双髂动脉闭塞,47例(24.1％)；Ⅲ型:单纯腹主动脉闭塞,6例(3.1％)；Ⅳ型:腹主动脉和双髂动脉闭塞,18例(9.2％)；Ⅴ型:近肾主髂动脉闭塞16例(8.2％).主要采用动脉旁路移植、动脉腔内治疗、杂交技术(腔内介入与旁路移植混合使用)、腹腔镜下主髂动脉重建等方法进行治疗,分析每种类型的治疗方法和疗效,对比疗效的差异.结果 所有类型踝肱指数(anklebrachial index,ABI)均有不同程度提高,各型患者间歇性跛行的距离均得到改善.静息痛除Ⅱ型中除1例患者减轻外,均症状消失.溃疡面缩小:Ⅰ型3例(60％)、Ⅱ型3例(50％)、Ⅳ型3例(100％)、Ⅴ型3例(75％)；足趾坏疽者变化者少,Ⅰ型5例、Ⅱ型3例、Ⅳ型4例均仅为1例脱落,Ⅲ型和Ⅴ型各1例均没有变化.Ⅰ型中有3例术中髂动脉破裂出血,均行及时处理(2.8％).随访(36.5±6.0)个月.Ⅰ-Ⅴ型随访的例数分别为98例(92.5％)、42例(89.4％)、6例(100％)、16例(88.9％)和15例(93.8％).Ⅰ型症状复发17例(17.3％):4例因同侧股腘动脉人工血管内膜增生基础上的血栓形成引起,4例与股-股动脉旁路移植血管桥再狭窄或者闭塞有关,9例因支架再狭窄或闭塞导致(9.8％),4例截肢(4.1％).足部溃疡和坏疽均愈合.Ⅱ型死亡3例(7.1％).复发13条肢体(15.5％):支架再狭窄或者闭塞5条(总计57条,8.8％),人工血管闭塞8例,膝上截肢1条肢体、膝下截肢3条肢体,截肢率为4.8％,其余4例经过人工血管切开取栓和吻合口处理,血管通畅.Ⅲ型无死亡,截肢1例为术后6个月行膝上截肢(8.3％).Ⅳ型死亡1例(6.3％),复发3例,1例为双下肢股腘动脉闭塞所致,目前药物治疗仍在随访中；另外2例为动脉旁路移植术后,其中1例经过取栓处理后症状消失,1例截肢(3.1％).Ⅴ型死亡1例(6.7％),1条肢体截肢(3.5％).复发4条患肢,除上述患者2条下肢外,另外1例患者双髂动脉支架重度再狭窄,经过SilverHawk斑块切除后支架通畅,症状消失.对比上述各型的血管通畅率和支架通畅率以及截肢率,差异均无统计学意义(P＞0.05).结论 (1)各型疗效无明显差别；(2)治疗主髂动脉闭塞主要有四种方式,每种治疗方式优缺点不同,临床可根据患者不同情况予以选择.
目的 分析主髂動脈閉塞外科治療的方法和療效.方法 迴顧性分析2004年1月至2012年12月收治的195例患者的資料,根據閉塞的部位不同分為5種類型.Ⅰ型:單髂動脈閉塞,108例(55.4％)；Ⅱ型:雙髂動脈閉塞,47例(24.1％)；Ⅲ型:單純腹主動脈閉塞,6例(3.1％)；Ⅳ型:腹主動脈和雙髂動脈閉塞,18例(9.2％)；Ⅴ型:近腎主髂動脈閉塞16例(8.2％).主要採用動脈徬路移植、動脈腔內治療、雜交技術(腔內介入與徬路移植混閤使用)、腹腔鏡下主髂動脈重建等方法進行治療,分析每種類型的治療方法和療效,對比療效的差異.結果 所有類型踝肱指數(anklebrachial index,ABI)均有不同程度提高,各型患者間歇性跛行的距離均得到改善.靜息痛除Ⅱ型中除1例患者減輕外,均癥狀消失.潰瘍麵縮小:Ⅰ型3例(60％)、Ⅱ型3例(50％)、Ⅳ型3例(100％)、Ⅴ型3例(75％)；足趾壞疽者變化者少,Ⅰ型5例、Ⅱ型3例、Ⅳ型4例均僅為1例脫落,Ⅲ型和Ⅴ型各1例均沒有變化.Ⅰ型中有3例術中髂動脈破裂齣血,均行及時處理(2.8％).隨訪(36.5±6.0)箇月.Ⅰ-Ⅴ型隨訪的例數分彆為98例(92.5％)、42例(89.4％)、6例(100％)、16例(88.9％)和15例(93.8％).Ⅰ型癥狀複髮17例(17.3％):4例因同側股腘動脈人工血管內膜增生基礎上的血栓形成引起,4例與股-股動脈徬路移植血管橋再狹窄或者閉塞有關,9例因支架再狹窄或閉塞導緻(9.8％),4例截肢(4.1％).足部潰瘍和壞疽均愈閤.Ⅱ型死亡3例(7.1％).複髮13條肢體(15.5％):支架再狹窄或者閉塞5條(總計57條,8.8％),人工血管閉塞8例,膝上截肢1條肢體、膝下截肢3條肢體,截肢率為4.8％,其餘4例經過人工血管切開取栓和吻閤口處理,血管通暢.Ⅲ型無死亡,截肢1例為術後6箇月行膝上截肢(8.3％).Ⅳ型死亡1例(6.3％),複髮3例,1例為雙下肢股腘動脈閉塞所緻,目前藥物治療仍在隨訪中；另外2例為動脈徬路移植術後,其中1例經過取栓處理後癥狀消失,1例截肢(3.1％).Ⅴ型死亡1例(6.7％),1條肢體截肢(3.5％).複髮4條患肢,除上述患者2條下肢外,另外1例患者雙髂動脈支架重度再狹窄,經過SilverHawk斑塊切除後支架通暢,癥狀消失.對比上述各型的血管通暢率和支架通暢率以及截肢率,差異均無統計學意義(P＞0.05).結論 (1)各型療效無明顯差彆；(2)治療主髂動脈閉塞主要有四種方式,每種治療方式優缺點不同,臨床可根據患者不同情況予以選擇.
목적 분석주가동맥폐새외과치료적방법화료효.방법 회고성분석2004년1월지2012년12월수치적195례환자적자료,근거폐새적부위불동분위5충류형.Ⅰ형:단가동맥폐새,108례(55.4％)；Ⅱ형:쌍가동맥폐새,47례(24.1％)；Ⅲ형:단순복주동맥폐새,6례(3.1％)；Ⅳ형:복주동맥화쌍가동맥폐새,18례(9.2％)；Ⅴ형:근신주가동맥폐새16례(8.2％).주요채용동맥방로이식、동맥강내치료、잡교기술(강내개입여방로이식혼합사용)、복강경하주가동맥중건등방법진행치료,분석매충류형적치료방법화료효,대비료효적차이.결과 소유류형과굉지수(anklebrachial index,ABI)균유불동정도제고,각형환자간헐성파행적거리균득도개선.정식통제Ⅱ형중제1례환자감경외,균증상소실.궤양면축소:Ⅰ형3례(60％)、Ⅱ형3례(50％)、Ⅳ형3례(100％)、Ⅴ형3례(75％)；족지배저자변화자소,Ⅰ형5례、Ⅱ형3례、Ⅳ형4례균부위1례탈락,Ⅲ형화Ⅴ형각1례균몰유변화.Ⅰ형중유3례술중가동맥파렬출혈,균행급시처리(2.8％).수방(36.5±6.0)개월.Ⅰ-Ⅴ형수방적례수분별위98례(92.5％)、42례(89.4％)、6례(100％)、16례(88.9％)화15례(93.8％).Ⅰ형증상복발17례(17.3％):4례인동측고객동맥인공혈관내막증생기출상적혈전형성인기,4례여고-고동맥방로이식혈관교재협착혹자폐새유관,9례인지가재협착혹폐새도치(9.8％),4례절지(4.1％).족부궤양화배저균유합.Ⅱ형사망3례(7.1％).복발13조지체(15.5％):지가재협착혹자폐새5조(총계57조,8.8％),인공혈관폐새8례,슬상절지1조지체、슬하절지3조지체,절지솔위4.8％,기여4례경과인공혈관절개취전화문합구처리,혈관통창.Ⅲ형무사망,절지1례위술후6개월행슬상절지(8.3％).Ⅳ형사망1례(6.3％),복발3례,1례위쌍하지고객동맥폐새소치,목전약물치료잉재수방중；령외2례위동맥방로이식술후,기중1례경과취전처리후증상소실,1례절지(3.1％).Ⅴ형사망1례(6.7％),1조지체절지(3.5％).복발4조환지,제상술환자2조하지외,령외1례환자쌍가동맥지가중도재협착,경과SilverHawk반괴절제후지가통창,증상소실.대비상술각형적혈관통창솔화지가통창솔이급절지솔,차이균무통계학의의(P＞0.05).결론 (1)각형료효무명현차별；(2)치료주가동맥폐새주요유사충방식,매충치료방식우결점불동,림상가근거환자불동정황여이선택.
Objective To evaluate the method and efficacy of surgical treatment for aortoiliac occlusive disease.Methods Clinical data of 195 patients treated in our hospital from January 2004 to December 2012 were analyzed retrospectively.Aortoiliac occlusive diseases were divided into 5 types according to locus of the occlusion,including Type Ⅰ,unilateral iliac artery occlusion; Type Ⅱ,bilateral iliac artery occlusion; Type Ⅲ,abdominal aorta occlusion; Type Ⅳ,the aorta and iliac artery occlusion; and Type Ⅴ,juxtarenal aortoiliac artery occlusion.There were 108 (55.4％),47 (24.1％),6 (3.1％),18 (9.2％),and 16 (8.2％) patients from type Ⅰ to Ⅴ,respectively.Surgical protocols included arterial bypass grafting,endovascular angioplasty,and hybrid procedures.Results Rest pain was disappeared almost in all patients except one patient got much improved; Intermittent claudication was improved in all types of patients ; Ankle brachial index (ABI) was increased in all patients.Foot ulcer was reduced in 3 (60％) patients of type Ⅰ occlusion,3(50％) in type Ⅱ,3(100％)in type Ⅲ,and 3(75％)in type Ⅴ;No dramatic change was found in foot gangrene in each type of disease.Rupture of iliac artery during operation was happened in 3 patients in type Ⅰ disease (2.8％)and were treated successfully.The average follow-up time was 36.5 months.The number of patients followed up in type Ⅰ-Ⅴ diseases were 98(92.5％),42 (89.4％),6 (100％),16 (88.9％) and 15 (93.8％),respectively.Symptoms were relapsed in 17 (17.3％) patients of Type Ⅰ disease including 8 of graft thrombosis and 9 of intrastent restenosis/occlusion and resulted in amputation of 4 limbs.Three patients were died (7.1％) in type Ⅱ disease.Relapse occurred in 13(15.5％) limbs including intrastent restenosis in 5(8.8％),and graft occlusion in 8.Graft thrombectomy was done successfully in 4 limbs.Above knee amputation was done in one limb and below knee amputation in 3 limbs with an amputation rate of 4.8％.Above knee amputation was done in one patient of type Ⅲ disease in the 6th postoperative month.Of the patients with type Ⅳ disease,one died (6.3％),3 had symptoms relapsed.One recurred due to bilateral femoropopliteal aretery occlusion that was treated conservatively.One recovered from thrombectomy.One underwent amputation (3.1％).Symptoms were relapsed in 4 lims of type Ⅴ disease and resulted in one patient's death(6.7％),one amputation(3.5％)and 2 successful arterial plaque excisions for intrastent restemosis.Statistical analysis of each type of disease found no difference in graft patency rate,intrastent patency rate and amputation (P ＞ 0.05).Conclusions All types of aortoiliac disease may be treated with equal efficacy; Choice of surgical procedures depends on both the characteristics of each protocol and the patients'condition.
