下肢动脉硬化闭塞症的诊断及治疗

Diagnosis and treatment of atherosclerosis obliterans in lower limb

目的探讨下肢动脉闭塞症合理的动脉重建术,讨论动脉硬化 X 线表现特点、治疗方法的选择及其结果。方法全组107例患者经皮动脉穿刺插管行双下肢动脉造影。根据动脉病变范围,选择手术和介入治疗。结果 107例176侧患肢(双侧69例,单侧38例)。单节段、2个动脉段、多节段动脉病变分别为38.6%、50%、11.4%。2个节段以上动脉病变的腘动脉远端病变率达72.7%。本组手术治疗72例,术后病死率4.2%,截肢率6.9%。各术式随访时间及通畅率分别为:内膜剥脱术3.8年,75%;主髂动脉旁路转流术3年,76.9%;自体大隐静脉股腘旁路转流术膝上吻合2.4年,71.4%;膝下吻合2.3年,72.7%;人工血管股腘旁路转流术膝上吻合1.2年,87.5%。膝下吻合2年,40%;多平面分段重建术1.8年,72.7%;经皮腔内血管成形术15例,2.8年,63.6%。结论动脉造影可明确动脉硬化病变范围,有利于选择不同的动脉重建方法,以取得良好的术后效果。

Objective 107 cases of atherosclerosis obliterans below abdominal aortic bifurcation were anal- ysed in order to find out an appropriate arterial reconstructive way.Methods Based on the findings of angiography on individual patients surgery or interventional theraphy was adopted.Results Lesions in the type of single segment,two segments and multiple segment were 38.6%,50%,and 11.4% respec- tively.Arterial reconstruction was performed in 72 cases,and percutaneous transluminal angioplasty in 15 cases.The postoperative mortality was 4.2%,amputation rate was 6.9%.The procedures adopted and results of aortoiliac endarterectomy,aortoiliac,femoral-popliteal,multilayer bypasses and percuta- neous transluminal angioplasty were discussed.Conclusion Satisfactory results in this series come from preoperative angiography on which the extent of lesions was evaluated and proper therapeutic measures were undertaken.