动脉旁路手术治疗慢性下肢缺血的中远期结果

Mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities

目的探讨慢性下肢缺血的动脉旁路治疗的中远期效果。方法回顾性分析2002年1月至2007年4月212例经动脉旁路治疗的慢性下肢缺血患者的临床资料。治疗方式包括股-膝上腘动脉旁路111例，股-膝下腘动脉旁路59例，主-髂动脉旁路25例，股股转流17例。结果术后186例（87．7％）获随访6～68个月（中位随访期18个月），股-膝上腘动脉旁路术与股．膝下腘动脉旁路术1年初次通畅率分别为69．7％、53．5％，二次累计通畅率为81．6％、60．5％，两者差异无统计学意义（P〉0．05）；其3年通畅率分别为56．3％和23．8％，两者差异有统计学意义（P〈0．05）；腹主．髂股旁路与股-膝上腘动脉旁路及股股转流术近远期通畅率差异均无统计学意义（P〉0．05）。随访期内52例患者行二次手术，23例行膝上或膝下截肢，保肢率为89．2％。围手术期死亡10例（4．7％），随访死亡20例，多数死于心脑血管原发疾病；人工血管感染6例。结论根据患者病情选用适当的旁路手术方式，可取得满意的效果。股-膝上腘动脉旁路中、远期通畅率高于股-膝下腘动脉旁路，两者近期通畅率无差异。

Objective To report the mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities. Methods The clinical data of 212 patients treated with bypass operation from January 2002 to April 2007 were retrospectively reviewed. Femoropopliteal artery bypass to above-knee popliteal（ FP-ak） was carried out in 111 cases, femoropopliteal artery bypass to below-knee popliteal（FP-bk） in 59 cases, aortoiliae bypass in 25 cases and femorofemoral bypass in 17 cases. Results One hundred and eighty-six patients （87. 7% ）were followed up for 6 to 68 months（ median, 18 months）. One-year primary patency rate of FP-ak and FP-bk was 69. 7% and 53. 5%, respectively. After graft revision, 1-year secondary patency rate of FP-ak and FP-bk were 81.6% and 60. 5%, respectively. The 3-year patency with FP-ak （56. 3% ） was significantly higher than that in FP-bk （23.8%） （P 〈0. 05）. Fifty-two cases were reoperated on during the follow-up period. Crural or femoral amputation could not avoid in 23 cases （limb salvage rate 89. 2% ）, Ten cases died in 1 to 30 days after the operation, 20 cases died later during follow up, and most of them died of cardio-cerebrovascular diseases. Artificial vessel infection occurred in 6 cases. Conclusions The selection of surgical treatment for chronic ischemia of lower extremities should based on the isehemic state of the limb. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.