股浅动脉闭塞122例治疗体会

Therapy Analysis of 122 Occlusive Superi cial Femoral Artery Diseases

目的总结股浅动脉支架与股-腘动脉人工血管旁路移植术治疗股浅动脉闭塞病变的效果。方法选取我院2008年1月至2011年4月期间接受经皮腔内血管成形术+支架置入术(简称"PTA/S术组")或股-腘动脉人工血管旁路移植术(简称"动脉旁路移植术组")治疗股浅动脉闭塞病变的122例患者(136条患肢)作为研究对象。记录患者的年龄、住院时间、术前合并症、术后并发症、TASCⅡ分级、远端流出道情况、一期通畅率、有无截肢、死亡等。结果 1 PTA/S术组有64例74条患肢,动脉旁路移植术组有58例62条患肢,PTA/S术组患者的年龄大于动脉旁路移植术组(P<0.05);PTA/S术组TASCⅡA、B级病变肢体所占比例较动脉旁路移植术组高(P<0.05),TASCⅡC、D级病变肢体所占比例较动脉旁路移植术组低(P<0.05);PTA/S术组拥有1条和3条远端流出道血管的患肢数目分别较动脉旁路移植术组多(P<0.05);2组患者拥有2条远端流出道血管的患肢数目、术前合并糖尿病、合病高血压、合病糖尿病及高血压以及术前吸烟史病例数比较差异均无统计学意义(P>0.05)。2 2组患者均无围手术期死亡患者;PTA/S术组的住院时间短于动脉旁路移植术组〔(7.2±1.2)d和(14.1±1.4)d,P<0.05〕;而术后3年死亡率PTA/S术组高于动脉旁路移植术组(4.7%比1.7%,P<0.05);切口感染率PTA/S术组低于动脉旁路移植术组(0比3.2%,P<0.05);2组患者截肢率比较差异无统计学意义(P>0.05);2组患者术后6、12及24个月一期通畅率比较差异无统计学意义(P>0.05),36个月一期通畅率动脉旁路移植术组明显高于PTA/S术组(50.0%比40.5%,P<0.05)。结论对于股浅动脉闭塞采用股-腘动脉人工血管旁路移植术能够获得较高的远期通畅率,但住院时间较长,个别患者会发生切口感染。股浅动脉球囊扩张成形+支架置入术手术创伤小,患者恢复快,住院时间短,对于年龄大,身体状况较差不能耐受股-腘动脉人工血管旁路移植术的患者有重要意义,但其远期通畅率有待进一步提高。

Objective To summarize the effects of endovascular intervention and artificial graft bypass for the occlusive superficial femoral artery disease. Methods The clinical data of 122 patients（136 limbs） with superficial artery occlusive disease underwent endovascular intervention or artificial graft bypass from January 2008 to April 2011 in this hospital were collected retrospectively. Age, TASC Ⅱ grading, condition of outflow tract, complications before and after procedures, hospital stay, primary patency rate, rate of amputation, and death rate were recorded. Results 1 Seventyfour limbs of 64 patients were accepted percutaneous transluminal angioplasty and stent graft（PTA/S group）, 62 limbs of 58 patients were accepted femoral popliteal artery artificial graft bypass（artificial graft bypass group）. Compared with the artificial graft bypass group, the age was significantly older（P〈0.05）, TASC Ⅱ A or B lesions were more（P0.05）, TASC Ⅱ C or D lesions were less（P〈0.05）, the limbs with one or three outflow tracts were more（P〈0.05） in the PTA/S group. The limbs with two outflow tracts, and the patients combined with diabetes or hypertension or diabetes and hypertension had no significant differences between these two groups（P〉0.05）. ② There was no perioperative mortality in two groups. Compared with the artificial graft bypass group, the average hospital stay was sifnificantly shorter（P〈0.05）, the 3-year death rate after procedure was higher（P〈0.05）, the rate of postoperative incision infection was lower（P〈0.05）, the primary patency rate of 36-month after operation was lower（P〈0.05） in the PTA/S group. The rate of amputation, the primary patency rates of 6-, 12-, and 24-month after operation had no significant differences between these two groups（P〉0.05）. Conclusions Management of occlusive superficial femoral artery disease with femoral popliteal artery artificial bypass grafting exhibits a higher long term patency as compared with percutaneous stent graft. However, the hospital stay is longer than that in PTA/S group, and postoperative infection also occurres individually in artificial graft bypass group. Percutaneous transluminal angioplasty and stent graft has little trauma, faster recovery, shorter hospital stay, which is an important significance for the patients with too old or weak to accept femoral popliteal artery artificial graft bypass. But its long term patency rate needs to be improved.