358例下肢动脉硬化闭塞症外科治疗效果分析

Surgery for lower-extremity arteriosclerotic occlusive disease

目的分析慢性下肢动脉硬化闭塞症外科治疗方法及疗效。方法回顾性分析2002年1月至2007年7月序贯治疗的358例慢性下肢动脉硬化闭塞症患者接受动脉搭桥或介入治疗后远期疗效。结果男293例，女65例，年龄（66±10）岁。本组接受了包括搭桥手术、介入治疗、截肢（趾）等外科治疗共413例（次）。失访48例，随访率86．6％，随访时间6～64个月。髂动脉支架介入治疗术后1、2、3年初次开通率高于腹主-髂-股动脉人工血管搭桥，差异无统计学意义（P〉0．05），也高于股（胭）动脉支架介入治疗术后初次开通率，但差异有统计学意义（P〈0．05）。股-胭动脉膝上人工血管搭桥术后1年的初次开通率略高于膝下搭桥，但差异无统计学意义（P〉0．01）；术后2、3年初次开通率均高于膝下搭桥，差异有统计学意义（P〈0．01）。股浅动脉球囊扩张成形术术后1年通畅率略低于胭动脉以远的球囊扩张术，但差异无统计学意义（P〉0．05）。全组截肢率为10．3％（37／358），围术期死亡率3．9％（14／358），随访期死亡率6．4％（23／358）。结论下肢动脉硬化患者根据病情选择适当的外科治疗方式，可以获得较高的术后通畅率。

Objective To evaluate the surgical results for patients with lower-extremity arteriosclerotic occlusive disease. Methods We performed a respective analysis of 358 patients who underwent various consecutive surgical treatments including open artery reconstruction and intervention in our hospital between 2002 and 2007. Results In this study, 358 patients （mean age 66 ± 10; 293 male, 65 female） experienced a total of 413 surgical interventions including traditional bypass, interventional surgery and amputation. Postoperatively 310 patients （86. 8% ） were followed up from 6 months to 64 months. The 1-year, 2-year and 3-year primary patency rates of iliac balloon angioplasty and stent placement were significantly higher than that of femoropopliteal balloon angioplasty and stentt placement （P 〈0. 01 ）, but not higher than that of aortoiliac or aortofemoral bypass （ all P 〉 0. 05 ）. The 2-year and 3-year primary patency rates of femoropopliteal bypass above knee were significantly higher than that of femoropopliteal bypass below knee （P〈0.01）, but that was not the case in 1-year group. There is no statistical difference in 1-year primary patency rates between femoropopliteal balloon angioplasty and distal popliteal balloon angioplasty （P 〉 0. 05 ）. Amputation rate was 8.7% （ 37/358 ）. Perioperative mortality was 3.9% （ 14/358 ）. Mortality during follow-up period was 6.4% （23/358）. Conclusion A satisfactory result can be obtained in most patients with the lower-extremity arteriosclerotic occlusive disease by using the appropriate surgical treatment.