腹主动脉末端硬化闭塞症的诊断与治疗

The diagnosis and surgical treatment of leriches syn-drome:an analysis of 1 6 cases

我院１９８７～１９９１年共收治１６例腹主动脉末端闭塞症。作者认为掌握本病的临床症状和体征的特点，选用合理的检查可以做到早期诊断。彩色多普勒应做为本病的首选检查方法，再佐以血管造影和ＤＳＡ检查，对判断闭塞的部位、范围和分型具有重要意义。踝／肱指数对诊断和指导治疗有意义。在鉴别诊断上应和骨科、神经内科、泌尿外科的一些疾病相鉴别。本病治疗难度很大，如不及时治疗预后不佳。本组１４例的手术术式是根据闭塞的部位、类型、范围、周身情况和流入流出道的情况而定。本组随访结果表明：腹主－髂总动脉间Ｙ型血管移植效果最佳，１年、５年累积通畅率分别为１００％、７５％。腋－股动脉旁路架桥１年、５年累积通畅率分别为１００％、３４％，效果最差。欲提高其远期通畅率必须采取综合疗法。

AbstractThe authors report 1 6 cases of atheroscleroticobliteration of the terminal abdominal aorta seen in theperiod of 1987～1991.Early diagnosis can be made byusing color doppler,and angiography and DSA are veryimportent to determinate the clinical patterns and oc-clusive locations.A/B Index is also valuable in the di-agnosis and treatment.Clinicaly,it should be differen-tiated from orthopedic,neurologic and urologic dis-eases. surgical procedure varies with occlusive loca-tion,clinical patterns, general status,and conditionsof the affected blood vessels,Follow-up found that Ytype aorto-femoral bypass get the best result with one-year unobstructed rate of 100%in all cases,and five-year cumulative unobstructed rate of 75%.The out-come of auxillaty-femoral bypass grafts were the leastsatisfactory, with the five-year cumulative unobstruct-ed rate of only 34%. Comprehensive therapy should beadopted to improve the long-term cumulative unob-structed rate.