股腘动脉闭塞腔内成形术与旁路转流术的临床疗效对比分析

Comparison of the clinical effects of endovascular therapy and bypass surgery for Trans-Atlantic Inter-Society Consensus Ⅱ C/D femoropopliteal artery disease

目的探讨股腘动脉闭塞行腔内治疗和旁路转流术的临床疗效。方法回顾性分析2008年1月至2011年12月本院收治的60例(67条肢体)股腘动脉闭塞(TASCⅡC/D型)患者的临床资料,其中腔内治疗41例(47条肢体,腔内治疗组),旁路转流术19例(20条肢体,旁路转流术组),比较两组患者的手术时间、术中出血量、术后恢复行走时间、踝肱指数(ABI)及随访1~4年的通畅率及保肢率。结果腔内治疗组术中出血量、手术时间及术后恢复行走时间明显少于旁路转流术组(P【0.01);两组术后ABI及技术成功率比较差异无统计学意义(P】0.05)。术后6~12个月的随访,腔内治疗组一期通畅率与旁路转流术组的通畅率比较,差异无统计学意义(43.6%vs 50.0%,P】0.05);术后18~48个月的随访,腔内治疗组二期通畅率及保肢率高于旁路转流术组,两组比较差异有统计学意义(79.5%vs 50.0%,P【0.05)。结论腔内治疗与旁路转流术治疗TASCⅡC/D型股腘动脉闭塞患者在短期内均能取得满意临床疗效及较好通畅率;但腔内治疗有着微创、术后恢复快等优点,且具有可重复操作性,有助于提高患肢远期血管通畅率。

Objective To investigate the clinical effects of endovascular therapy and bypass surgery for femoropopliteal atherosclerotic occlusive disease of the lower limbs. Methods The data of 60 patients (67 limbs) with TASCⅡC/D femoropopliteal artery disease in our centre from Jan. 2008 to Dec. 2011 were analyzed retrospectively. All cases were divided into two groups based on treatment:endovascular group (41 cases, 47 limbs) and bypass group (19 cases, 20 limbs). The parameters of the operation time, the blood loss in operation, postoperative recovery of walking time and ankle brachial index (ABI) as well as the patency rate and limb salvage rate during the 1~4 years of follow-up. Results The operation time, the blood loss in operation and postoperative recovery of walking time of endovascular group are lower than those of bypass group (P<0.01). They were no significant differences in ABI and technical success rate between endovascular group and bypass group(P>0.05). During the follow-up with a time of 6~12 months, there were no statistically significant differences in the primary patency rate and limb salvage rate between two groups (43.6%v s 50.0%,P>0.05). However, the secondary patency rate and limb salvage rate of endovascular group are higher than that of bypass group after operation 18~48 months (79.5%v s 50.0%, P<0.05). Conclusions Both the endovascular therapy and bypass surgery can get great clinical effect and high patency rate for TASCⅡC/D arteriosclerotic occlusion of femoropopliteal artery in short-term, but endovascular therapy has better long-term patency rate because of its minimal invasion, rapid postoperative recovery and repetitive operation.