杂交手术治疗多节段股腘动脉病变疗效观察

HYBRID PROCEDURES FOR MULTILEVEL FEMORAL AND POPLITEAL ARTERY OCCLUSIVE DISEASE

目的探讨杂交手术治疗累及股动脉至胭动脉的多节段动脉硬化病变的疗效。方法2009年6月-2012年6月，对22例累及股动脉至胭动脉的多节段动脉硬化病变患者采用杂交手术治疗。其中男15例，女7例；年龄52～78岁，平均66．2岁。根据临床症状分为Fontaine III级8例，Ⅳ级14例。病程6个月～5年，平均1．5年。术前踝肱指数（ankle brachial index，ABI）为0．32±0．18，足背经皮氧分压（transcutaneous oxygen pressure，Tcp02）为（17．6-I-11．6）kPa，间歇性跛行距离为（160±54）rn。其中13例有吸烟史；合并2型糖尿病8例，高血压16例，高血脂10例，冠心病11例，慢性肾衰竭1例。术后评价患者临床症状改善情况，采用Kaplan—Meier生存分析及Log．rank检验比较不同Fonmine分级患者间一期通畅率、辅助一期通畅率及二期通畅率。结果手术均顺利完成，手术时间70～160rain，平均137min。术后1例发生急性心肌梗死，1例局部切口血肿、感染，1例股浅动脉支架断裂，1例股浅动脉支架内血栓形成。术后6个月患者ABI、足背TcpO2、间歇性跛行距离分别提高至0．79±0．33、（42．7±15．7）kPa、（420±80）m，与术前比较差异均有统计学意义（P〈0．05）。术后患者均获随访，随访时间6～24个月，平均14．5个月。一期通畅率为77．3％（17／22），辅助一期通畅率为90．9％（20／22），二期通畅率为95．5％（21／22），三者比较差异均无统计学意义（P〉0．05）。FonmineIII级和Ⅳ级患者间各期通畅率比较，差异均无统计学意义（P〉0．05）。结论杂交手术治疗流出道良好的累及股动脉至胭动脉的多节段动脉硬化病变安全有效。

Objective To evaluate the immediate and mid-term effectiveness of hybrid procedures （combined open surgery and endovascular therapy） for multilerel femoral and popliteal artery occlusive disease. Methods Between June 2009 and June 2012, 22 cases of severe femoral and popliteal artery occlusive disease were treated by hybrid surgery. There were 15 men and 7 women with an age range of 52-78 years （mean, 66.2 years） and with a disease duration of 6 months to 5 years （mean, 1.5 years）. Of 22 patients, 13 had a history of smoking; 8 were classified as Fontaine III and 14 as Fontaine IV. The complications included diabetes （8 patients）, hypertension （16 patients）, hyperlipemia （10 patients）, coronary heart disease （11 patients）, and chronic kidney failure （1 patient）. Patency analyses were performed using Kaplan-Meier life tables and log-rank test. Results All patients underwent successfully procedures. The time of operation was 70-160 minutes （mean, 137 minutes）. Acute myocardial infarction, hematoma of incision, fracture of stent, and stent thrombosis occurred in 1 case, respectively. At 6 months after surgery, the ankle brachial index （ABI）, the transcutaneous oxygen pressure （TcpO2）, and the average intermittent claudication distance were significantly increased when compared with preoperative ones [0.79 ± 0.33 vs. 0.32 ± 0.18, （42.7 ± 15.7） kPa vs. （17.6 ± 11.6） kPa, and （420 ± 80） m vs. （160 ± 54） m, P 〈 0.05]. The patients were followed up 6-24 months （mean, 14.5 months）. The primary patency rate, primary assisted patency rate, and second patency rate were 77.3% （17/22）, 90.9% （20/22）, and 95.5% （21/22） respectively, showing no significant difference among them （P 〉 0.05）. No significant difference was found in various-stage patency rates between patients at Fontaine III and IV （P 〉 0.05）. Conclusion Hybrid procedures provide an effective treatment of multilevel femoral artery and popliteal artery disease while there is good outflow.