下肢动脉闭塞性疾病的外科治疗

Surgical procedures of peripheral arterial occlusive disease

目的:探讨下肢动脉闭塞性疾病外科手术方案的选择及其对移植血管远期通畅率的影响。方法:自1998年12月至2002年12月手术患者中,有80例得到完整随访,按照不同手术方案分组,结合随访结果,统计远期通畅率。结果:移植血管近期通畅率98.5%;1年、3年、5年远期通畅率分别为82%、71%、57%。腹股沟以上动脉旁路术中,移植血管5年通畅率85%;腹股沟以下动脉旁路术血管5年通畅率54%。腹股沟以下动脉旁路术中,移植血管采用自体大隐静脉5年通畅率66%,而采用PTFE人工血管5年通畅率41%(P=0.022)。结论:术前详细评估,结合患者状况制订个体化手术方案,选择适宜的移植物,完善围手术期处理,才能降低手术并发症及死亡率,提高远期治疗效果。

Objective：To evaluate suitable surgical protocols chosen for different types of peripheral arterial occlusive disease （PAOD）, and its effect to the long-term patency rate. Methods： 80 cases of PAOD were grouped, reviewed with their follow-up to compare the longterm effect of different surgical strategies. Results：The short term patency rate in this group was 98.5%. the cumulative patency rate of 1 year, 3 years, 5 years was 82%, 71%, 57% ,respectively. The 5 year patency rate for ＋ suprainguinal bypass was 85% in this group. And in those infrainguinal bypass cases, the 5 year patency rate was 66% for vein graft, and 41% for PTFE graft. Conclusion：Comprehensive preparation and individualized surgical procedure should be made for each PAOD patient to decrease the mortality and complication, and improve the long term treatment effect.