自体大隐静脉移植治疗下肢动脉硬化闭塞症30例

Surgical treatment of atherosclerotic occlusion of the lower limbs by autogenous great saphenous vein grafting

目的:探讨自体大隐静脉移植治疗下肢动脉硬化闭塞症的临床疗效.方法:采用自体大隐静脉移植术治疗下肢动脉硬化闭塞症30例,通过手术治疗前后的比较及12～36个月随访,分析该手术的临床疗效及自体大隐静脉移植物的远期通畅率.结果:28例术后缺血症状消失,1例无改善,1例术后截肢,手术治疗总有效率为93.3%(28/30).临床表现为下肢疼痛消失,皮肤温度变暖,溃疡趋于愈合,踝肱指数均值由0.45升为0.86,与术前相比有显著性差异(P＜0.01).随访结果表明,术后1～3年移植血管累计通畅率分别为92.8%(26/28),85.7%(24/28)和75%(21/28).结论:自体大隐静脉移植符合下肢循环重建的解剖生理,移植血管长期通畅率高,是治疗下肢动脉硬化闭塞症的合理手术方式.

Objective： To evaluate the clinical effects of autogenous great saphenous vein grafting on the surgical treatment of atherosclerotic occlusion of the lower limbs. Methods ：30 cases with lower limbs atherosclerotic occlusion were performed by autogenous great saphenous vein graft bridge during the period from July, 2000 to June, 2003 in our hospital. The immediate surgical results were compared with that of pre-operation, and the long-term patency of the vein grafts were analysed by the patients＇ follow-up. Results： Total relief was seen in 28 cases with their limbs pain disappearing, skin temperature going up, and the refractory ulcer tending to heal. There was a significant difference of ABI as compared before and after the surgery, which increased from 0.45 to 0.86 （P〈0. 01）. The overall effective rate reached 93.3% （28/30）. Meanwhile, no improvement was seen in 1 case and the other 1 case was re-performed by the amputation after the vein grafting bridge. The follow-up survey showed that the patency rate of the autogenous vein graft after the performance was 92.8%（26/28）, 85.7% （24/28） and 75%（21/28）, respectively. Conclusion： Autogenous great saphenous vein grafting is the best choice in the surgical treatment of the lower limbs atherosclerotic occlusion. To be strict with the surgical indications, to select the suitable in-flow vessels in the distal end and to contral the coincidential diseases play an important in roling in assuring the surgical outcome and long-term patency of the vein graft.