应用人工血管移植物转流治疗Leriche综合征78例(英文)

Vascular prosthesis graft bypass in the treatment of 78 patients with Leriche syndrome

背景:针对腹主动脉闭塞引起下肢慢性缺血的Leriche综合征的治疗,尚缺乏有效恢复血管弹性和闭塞血管再通的药物。应用人工血管移植血管流出道重建可迅速改善远端肢体的血运。目的:评估人工血管移植干预Leriche综合征的生物相容性,并观察治疗效果。设计:前后对照观察。单位:解放军总医院普通外科,北京市石景山医院心胸血管外科。对象:选择Leriche综合征患者78例,包括于1995-01/2007-01解放军总医院普通外科收治的62例及2001-01/2007-01北京市石景山医院心胸血管外科收治的16例。男66例,女12例;年龄46～75岁,平均58岁。发病时间6个月～8年,平均2年6个月。患者对治疗方案均知情同意。方法:均在全身麻醉或硬膜外麻醉下行血管转流,其中主-股转流63例,主髂转流15例,采用人工血管作为移植物,其中PTFE人工血管18例,聚酯(polyester)人工血管60例。PTFE人工血管由美国Gore公司提供,为膨体聚四氟乙烯人工血管,是一种惰性材料,生物反应较轻,其纤维呈非规则的随意排列,并具有微孔。聚酯人工血管为法国Intervascular公司生产的针织聚脂产品,这种针织聚脂人工血管采用高纯度I型牛胶原制成,具有高度生物相容性,同时在胶原涂层的血管表面镶嵌能保留4周的肝素分子,具有预防血栓形成和抑制平滑肌细胞过度增生的作用;所用型号IGK1608,主干内径为16mm,分支内径为8mm。治疗方案经医院伦理委员会批准。采用回院复查的方法通过彩色血管多普勒、SCTA三维重建或DSA血管造影,SCTA检查对患者进行3个月～5年随访。主要观察指标:人工血管生物相容性;人工血管移植治疗效果。结果:①人工血管生物相容性:人工血管移植后3个月复查,彩色超声以及SCTA检查血管吻合口及人工血管内均未见血栓。77例获得1年以上的随访,吻合口均通畅。76例获得5年以上随访,吻合口通畅率为89%(68/76)。血管移植后血小板、白细胞计数、血红蛋白、肝肾功能无与血管移植相关的变化。②疗效:血管移植后7d,患肢缺血症状均得到改善。人工血管移植后3个月,患肢缺血症状消失,64例阳痿现象得到明显改善。结论:利用人工血管移植行血管重建,人工血管生物相容性良好,主动脉股动脉转流或主动脉髂动脉转流后治疗Leriche综合征疗效佳。

BACKGROUND： Effective drugs for improving vascular elasticity and revascularization are few for treating Leriche syndrome （chronic lower extremities ischemia） induced by abdominal aortic occlusion. Vascular outflow tract reconstruction in vascular prosthesis transplantation can rapidly improve blood supply in the distal extremities. OBJECTIVE： To evaluate the biocompatibility and outcome of vascular prosthesis transplantation for the treatment of Leriche syndrome. DESIGN： Controlled study before and after surgery. SETTING： Department of General Surgery of General Hospital of Chinese PLA and Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital. PARTICIPANTS： Sixty-two patients and sixteen patients with Leriche syndrome were enrolled in this study, who were respectively from Department of General Surgery of General Hospital of Chinese PLA between January 1995 and January 2007 and from Department of Thoracic and Cardiovascular Surgery of Shijingshan Hospital between January 2001 and January 2007. The subjects were 66 males and 12 females, whose age ranged from 46 75 years （averagely 58 years） and onset time from 6 months 8 years （averagely 2 years and 6 months）. Informed consents were obtained from all patients. METHODS： After general anaesthesia or epidural anesthesia, vascular bypass was performed, including aortofemoral bypass in 63 cases and aortoiliac bypass in 15 cases. Vascular prostheses included polytetrafiuoroethylene （PTFE） vascular prosthesis in 18 cases and polyester vascular prosthesis in 60 cases. PTFE vascular prosthesis （Gore, USA） is a kind of inert material with low biological response. Its fibers with micropores arrange irregularly. Polyester vascular prosthesis （Intervascular, France） is a kind of knitting polyester products, which is made from high-purity cattle collagen I with high biocompatibility. To inlay heparin molecules that can retain 4 weeks into the surface of vessels coated with collagen can prevent thrombogenesis and inhibit hyperplasy of smooth muscle cells （SMC）. The type is IGK1608; internal diameter of the bole is 16 mm; internal diameter of the branch is 8 mm. Therapeutic prescriptions were approved by Hospital＇s Ethics Committee. Follow-up was performed for 3 months-5 years by vascular Color Doppler Sonography, spiral CT angiography （SCTA） three-dimensional reconstruction or digital subtraction angiography （DSA） in hospital. MAIN OUTCOME MEASURES： Biocompatibility of vascular prosthesis and outcome of vascular prosthesis transplantation. RESULTS： Three months after vascular prosthesis transplantation, thrombus was not detected on vascular anastomosis and in vascular prosthesis by Color Doppler Sonography and SCTA. Seventy-seven patients were followed up for over one year, and their stomas were unobstructed. Seventy-six patients were followed up for over five years, and the patency rate of stomas was 89% （68/76）. No changes in blood plaque, lencocyte count, haematoglobin or liver and kidney function were found after transplantation. Seven days after surgery, affected extremities with ischemic symptom were improved. Three months later, ischemic symptom disappeared. CONCLUSION： With good biocompatibility of vascular prosthesis, vascular prosthesis transplantation in the treatment of Leriche syndrome has a good outcome following aortofemoral bypass and aortoiliac bypass.