摘要
目的评价健侧髂外动脉-患侧恫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6l例，女性24例；年龄64-91岁，平均年龄75岁。按Fontaine分期，Ⅱb－Ⅲ期62例（72．9％），Ⅳ期23例（27．1％）。根据患肢股深动脉及膝上、下胴动脉显影状况，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胭动脉血流速度为（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一股浅动脉硬化闭塞症安全有效，尤其适宜高危老年患者。
Objective To report and evaluate the clinical results of surgical treatment fbr long- segment iliofemoral arteriosclerosis obliterans, including extelaaal iliac-popliteal （EIP） and femoral-deep femoral （FDF） crossover bypass surgeries. Methods From July 1995 to December 2009, 85 patients （61 male, 24 female, aged from 64 to 91 years, mean age 75 years） with comprehensive unilateral lilac- superficial femoral arteriosclerosis obliterans were involved in this research. According to Fontaine classification, the 85 patients could be graded as 62 class Ⅱb-Ⅲ patients （72.9%） , and 23 class Ⅳ patients （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 visualizations in the affected deep femoral, supra- knee/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 analyzed. Results None 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 years）. 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） cm/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% and57. 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 iliae-superficial femoral artery occlusive disease, especially suitable for high-risk patients. EIP group patients have better clinical outcomes than those in FDF group.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第4期306-309,共4页
Chinese Journal of Surgery
关键词
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
Arteriosclerosis, obliterans
Iliacartery
Femoral artery
Vascular surgicalprocedures
Blood vessel prosthesis implantation
