小隐静脉原位旁路术治疗下肢动脉缺血症

IN SITU SMALL SAPHENOUS VEIN BYPASS FOR LOWER LIMB ISCHEMIA

为了探讨下肢动脉缺血症旁路重建术新的移植材料，１９９２年５月～１９９７年５月应用小隐静脉原位旁路术治疗下肢动脉闭塞严重缺血症１８例２４条肢体，监测随访１～５年，近期缺血症状改善显著，临床有效率达８８．８％，远期疗效优良率达８３．３％。经寿命表法统计分析，移植物１，３，５年通畅率分别为９３％，８５％，７６％。认为以小隐静脉为移植材料重建制备肢体循环具有不受长度限制，无需预破坏瓣膜、不必全程结扎属支，避免了反转与扭曲，减少了损伤等优点，是一种治疗下肢长段动脉硬化闭塞、血栓闭塞性脉管炎，月国动脉以下三分支闭塞患者理想的术式，并提出任何循环重建术都并非病因治疗。为提高ＡＳＯ，ＴＡＯ的治愈率，降低截肢率，中西医结合。

In order to investigate new graft materials for bypass reconstruction of lower limb ischemia,18 patients with 24 ischemic lower limbs were treated with in situ small saphenous vein bypass from May 1992 to May 1997. Follow-up examinations were performed one to five years postoperatively. The short term results showed significant improvements in ischemic symptoms and an effective rate of 88.8%. Good or excellent long term results were observed in 83.3% of the cases. The potency rate of the graft after one, three and five years lifetime analysis,was 93%, 85%and 76%,respectively. The small saphenous vein should be used as the graft material in order to reconstruct the circulation of the ischemic leg when the patient has lower limb long segment arteriosclerosis obliterans (ASO) and thromboangitis obliterans (TAO) with the occlusion of three branches inferior to the popliteal artery. The advantages of this method are that there is no length limit, a reduction in the amount of unnecessarily damaged valves and ligating branches in full course in order to reduce injury and avoid reversion and distortion. Moreover,the results suggest that circulation reconstruction is not pathogenetic treatment. In order to increase the success rate of ASO and TAO and decrease the amputation rate, the most promising direction for research is the integration of traditional Chinese medicine and western medicine as well as the combination of internal medicine and surgery.