摘要
目的评估锁骨下动脉支架植入术、腋一腋动脉旁路移植术（axilloaxillary bypass，AAB），颈．锁骨动脉旁路移植术（carotid—subclavian bypass，CSB）治疗锁骨下动脉硬化闭塞症的安全性及中远期疗效。方法2001年1月至2013年1月首都医科大学宣武医院共手术治疗311例锁骨下动脉硬化闭塞症患者，其中男239例，年龄32—85岁，平均年龄（63±9）岁。锁骨下动脉支架植入术191例，AAB96例，CSB32例。平均随访（32±11）个月，观察围术期并发症及中远期通畅率。结果锁骨下动脉支架植入术，AAB，CSB3种术式围术期并发症分别为4．1％（9／191），11．5％（11／96），18．7％（6／32）。支架植入术围术期并发症低于开放手术，AAB与CSB术式围术期并发症差异无统计学意义；锁骨下动脉支架植入术1，3，5年通畅率分别为90．3％，84％，81．6％；AAB组1，3，5年通畅率分别为：95．3％，92．6％，88．9％；CSB组1，3，5年通畅率：100％，96．4％，96．4％。两种旁路移植组的通畅率高于支架植入组。结论锁骨下动脉支架植入术、CSB，AAB是治疗锁骨下动脉硬化闭塞症安全有效的治疗方式。外科旁路手术移植术的中远期通畅率优于支架植入术。
Objective To investigate the safety and medium-and long-term effects of endovascular stenting, axilloaxillary bypass （ AAB）, carotid-subclavian bypass （ CSB ） in patients of subclavian arterial occlusion. Method From 2001 to 2013, 311 consecutive patients with subclavian arteriosclerosis obliterans were treated with endovascular stenting （ n = 191 ）, axilloaxillary bypass （ n = 96 ） or carotidsubclavian bypass （ n = 32）. We collected patients＇ medical data, calculated patency of the graft or stent with life-table method and compared patency between three approaches with Log-rank. Results The incidence of perioperative complications was 4. 1% in the stenting group vs. 11.5% in AAB group vs. 18.7% in CSB group. There was significant statistical differences between the stenting group and bypass group about the incidence of perioperative complications. The primary patency rates at 1,3 and 5 years were 90. 3%, 84% , 81.6% in stenting group vs. 95.3% , 92. 6% , 88.9% for AAB group vs. 100% ,96.4% ,96.4% for CSB group. There was significant statistical differences between the stenting group and bypass group about the primary patency rates. Conclusions Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian arteriosclerosis obliterans. However, effect of extrathoracic surgical bypass is more durable in the medium-and long-term.
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第4期283-286,共4页
Chinese Journal of General Surgery
