一站式杂交手术治疗动脉硬化闭塞症复杂病变

One-stop Hybrid Therapy for Complex Arteriosclerosis Obliterans:22 Cases Report

目的探讨一站式杂交手术治疗下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）多节段复杂病变的临床效果。方法2005年1月-2007年12月采用一站式杂交手术治疗ASO多节段病变患者22例,行股总动脉切开动脉内膜切除或Fogarty导管取栓＋PTA＋STENT（逆行）＋股腘旁路或股股旁路10例,切开股总动脉Fogarty导管取栓或动脉内膜切除术＋PTA＋STENT（顺行）7例,切开股总动脉行动脉内膜切除术同时逆行、顺行PTA＋STENT5例。结果手术成功率为100%,术后静息踝肱指数由术前0.38升高0.61（P〈0.0001）;运动后踝肱指数由术前0.30升至0.60（P〈0.0001）。分别于术后3、6、9、12个月进行临床评估及彩超检查,1例11个月死于重症肺炎,2例再狭窄,1年通畅率90.5%（19/21）。结论一站式杂交手术治疗多节段复杂病变的下肢动脉硬化闭塞症患者安全、创伤小、通畅率高。

Objective To discuss the clinical effect of one-stop hybrid （combined surgical-endovascular） therapy for complex arteriosclerosis obliterans （ASO）. Methods From January 2005 to December 2007, 22 ASO cases were treated by one-stop hybrid therapy. The procedures were as follow as： common femoral arteriotomy （CFA） and endarterectomy （or embolectomy of Fogarty catheter） and retrograde- PTA and STENT and crossed femorofemoral （or femoropopliteal） bypass in 10 cases, CFA and embolectomy of Fogarty catheter （or endarterectomy） and antegrade- PTA and STENT in 7 cases, and CFA and endarterectomy and retrograde- and antegrade- PTA and STENT in 5 eases. Results The technical success rate was 100%. The rest ankle braehial index （ABI） was improved markedly from 0.38 preoperatively to 0.61 postoperatively （P 〈 0.0001 ）, the postexereise ABI was increased obviously from 0. 30 preoperatively to 0. 60 pestoperatively（ P 〈0. 000l ）. All cases received clinical assessment and color Doppler uhrasonography exam at 3, 6, 9 and 12 months after the operation. One ease died of severe pneumonia at 11 months after treatment. 2 eases were found restenosis. 19 patients remained free of symptoms without any secondary intervention. The pateney rate was 90.5%. Conclusion Onestop hybrid therapy is a safe and mini-traumatic treatment for complex ASO with high long-term patency rate.