动脉硬化闭塞症下肢缺血的手术治疗(附28例报告)

Treatment for arteriosclerotic obliterance in ischemia of lower extremities

目的探讨动脉硬化闭塞症（ASO）下肢缺血的手术效果。方法选择1997~2009年FontaineⅢ、Ⅳ期下肢动脉硬化闭塞症患者28例,采用旁路术、内膜剥脱术及股深动脉成形术重建股深动脉血流。结果21例FontaineⅢ期患者于术后肢体静息痛消失;7例FontaineⅣ期患者术后肢体静息痛消失6例,于术后10 d行截足（趾）术;1例术后静息痛减轻,3个月后彩色多普勒显示人工血管闭塞,行膝下截肢。22例患者得到随访,随访时间3个月~8年。移植血管5年通畅率为86%。结论股深动脉血流重建、旁路术、内膜剥脱术治疗严重肢体缺血具有简单、安全、有效的优点,适合年老体弱不能耐受复杂手术的患者。

Objective To study the effect of operations for the patients with arteriosclerosis obliterances in lower extremities.Methods 28 cases arteriosclerotic obliterance of lower extremities of Fontaine Ⅲ and Ⅳ from 1997~2009 were selected to conduct the bypass,thrombendarterectomy and femoral profundaplasty to rebuild femoral profound artery blood flow.Results The low limbs rest pain disappeared in the 21cases suffering from Fontaine Ⅲ after operations;6 patients＇ low limbs rest pain were relieved among 7cases of Fontaine Ⅳ and foot/toe.Amputations were carried out 10 days after the operation：One case of rest pain was relieved after the operation and the below-knee-amputation was done after the vascular grafts occlusion was shown with CDFI.The follow-up visits were conducted on 22 cases with the period from 3 months to 8 years.The results indicated that for 86% of patents their blood flow smooth rate was improved on the prothetic graft after 5 years.Conclusion Treatment of the severe lower limb ischemia by means of femoral profundaplasty,bypass and thrombendarterectomy features simplicity,safety and effectiveness especially for the old,weak patients and those who do not tolerate the complicated operations.