血管腔内介入联合外科手术治疗下肢多节段动脉硬化闭塞症
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金星

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Endovascular stenting combined with conventional surgery for treatment of lower extremity multilevel atherosclerotic occlusive disease
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    目的: 探讨下肢多节段动脉硬化闭塞症的治疗手段及临床疗效。方法:2004年3月—2006年1月,采用髂动脉球囊扩张和支架植入结合动脉旁路术、股深动脉成形术治疗下肢多节段动脉硬化闭塞症21例(24条患肢)。24条患肢行髂动脉球囊扩张和支架植入术,其中12条患肢加行股深动脉成形术,14条患肢加行股-腘动脉人工血管转流术。结果:手术均获得成功,未出现严重并发症。术后踝肱指数0.63 ±0.18与术前0.24±0.13相比有明显提高(P<0.05)。平均随访13个月(1~23个月)。与术前相比患者症状明显改善,仅4例残余有间歇性跛行(跛行距离300~500m),其中3例术后3个月行干细胞移植术后症状明显好转,跛行距离加大(>1 000m)。结论:髂动脉腔内介入结合动脉旁路术、股深动脉成形术是治疗多节段多平面下肢动脉硬化闭塞症的有效方法。手术创伤小,操作方便。手术方式灵活,尤适用于高危重症患者。

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    Abstract:Objective:To study the treatment of multilevel atherosclerotic occlusive disease of the lower extremity. Methods:From March 2004 to January 2006,intraoperative iliac balloon angioplasty and stenting combined with simultaneous vascular bypass and profundoplasty were performed on 24 limbs in 21 patients suffering from lower extremity multilevel atherosclerotic occlusive disease. In 24 limbs iliac balloon angioplasty and stent placement were performed with simultaneous profundoplasty in 12 limbs and femoro-popliteal bypass in 14 limbs. Results:Surgical procedures were technically successful in all patients. There were no severe postoperative morbidity or mortality. Before-operative vs postoperative ABI was 0.24±0.13 vs 0.63±0.18(P<0.05) . The mean following-up period was 13 months (range of 1 to 23 months). Follow-up observations found that none of the patients had rest pain, but four patients had intermittent claudication, 3 of them received autologous bone stem cell transplantation 3 months after the operation and the claudication markedly improved. Conclusions:Simultaneous intravascular interventional therapy combined with vascular bypass and profundoplasty are effective in the treatment of patients with severe and multilevel atherosclerotic occlusive diseasis of the lower extremity. The operation is less traumatic and the procedures are easy to do. The operative method is flexible and is especially suitable for high risk patients.

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王瑞华,金星,吴学君,种振岳,张十一,董典宁.血管腔内介入联合外科手术治疗下肢多节段动脉硬化闭塞症[J].中国普通外科杂志,2006,15(5):2-324.
DOI:10.7659/j. issn.1005-6947.2006.05.002

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  • 在线发布日期: 2006-05-25