重症下肢动脉缺血的诊治

Diagnosis and treatment of critical limb ischemia

目的探讨重症下肢动脉缺血的手术治疗效果。方法回顾性分析123例（137侧肢体）重症下肢缺血（Fontaine Ⅳ期）患者的治疗方法及疗效，患者平均年龄（74±9）岁，男79例，女44例，33．33％有吸烟病史，43．09％合并冠心病，50．41％合并高血压，29．27％合并脑血管病，52．33％合并糖尿病。其中介入治疗15侧肢体，手术治疗118侧肢体，介入联合手术治疗4侧肢体。结果围手术期死亡率4．88％。随访率88．89％，随访时间2—74个月，平均（18±18）个月，随访期间死亡率13．01％。术后1、2、3年通畅率分别为（81±4）％、（68±6）％、（61±7）％。动脉闭塞25例，再手术4例，截肢9例。溃疡或坏死创面术后半年愈合率78．85％（82／104），1年愈合率83．65％（87／104）。术后1、2、3年保肢率分别为（81±4）％、（71±5）％、（65±6）％。结论重症下肢动脉缺血患者通过介入及或手术方法动脉重建可以达到满意的血管通畅率，促进创面愈合，降低截肢平面，提高保肢率。

Objective To evaluate the clinical result of arterial reconstruction in critical limb ischemia. Methods Clinical data of 123 cases （137 lower extremities） of critical limb ischemia （Fontaine Ⅳ ）, 79 males and 44 females, with a mean age of （74 ± 9 ） years, undergoing arterial reconstruction, were reviewed. Comorbidities included tobacco use （33.33%）, coronary artery disease （43.09%） , hypertension （ 50. 41% ） , cerebral vascular disease （ 29.27% ） , and diabetes mellitus （52. 33% ）. Result Perioperative mortality rate was 4. 88% , and 88.89% cases were followed up with a mean time of （18 ± 18）months and the mortality rate was 13.01%. The postoperative pateney rate of 1 year, 2 years and 3 years was （81±4）%, （68±6）% and （61±7）% respectively. Arterial occlusion occurred in 25 cases, 4 cases received reoperation and 9 cases received major amputation. Tissue healing rate was 78.85% after half a year and 83.65% after 1 year. The limb salvage rate was （81±4）% , （71 ± 5 ）% and （65 ± 6）% after 1 year, 2 years and 3 years respectively. Conclusion Arterial reconstruction for the critical limb ischemia increases the limb salvage rate with satisfactory patency rate and improves the healing of ulcer.