90例重症下肢缺血的治疗体会

Surgical management of severe ischemia of the lower limbs in 90 cases

目的 探讨重症下肢缺血的治疗方法。方法 90例（97条肢体）重症下肢缺血患者中76．3％（74／97条肢体）行下肢动脉旁路转流术，流出道直接位于膝上者为36．5％（27／74条肢体），膝下者31．1％（23／74条肢体），多节段旁路转流32．4％（24／74）条肢体；21．6％（21／97）条肢体一期行截肢术；2．1％（2／97）条肢体保守治疗。结果 下肢动脉旁路转流术后，保肢率为90．5％，围手术期死亡率4．4％。术后平均随访（26±24）个月，肢体缺血改善率84．4％，保肢率92．2％，血管通畅率75％。结论 重症下肢缺血患者通过选择恰当的血管重建方式，可以获得满意的血管通畅率和保肢率。

Objective To evaluate the clinical results of graft bypass for the management of severe ischemia of the lower extremities. Methods This study included 90 patients （97 lower extremities）, of which 76.3% （74/97） lower extremities underwent graft bypass procedures, with 36. 5% （27/74）outflow being directly above the knee, 31.1% （23/74） below the knee, and 32.4% （24/74） graft outflow being multilevel; 21.6% （21/97） extremities underwent one stage amputation; The remaining 2. 1% （2/97） extremities were put on conservative therapy. Result In the patients with graft bypass, postoperative limb salvage rate was 90. 5% ,perioperative mortality was 4. 4%. Mean follow-up period was （26 ±24） months with an improvement rate of limb ischemia of 84. 4%, limb salvage rate was 92. 2% , bypass graft patency rate was 75%. Conclusion We can improve the limb salvage and graft patency by selecting the correct revascularization.