全腹腔镜和开腹主股动脉旁路术治疗主髂动脉硬化闭塞中远期疗效观察

Medium-long term observation of total laparoscopic and open aorto-femoral artery bypass in treating aorta-iliac occlusive diseases

目的:观察单中心全腹腔镜和传统开腹主股动脉旁路手术的中远期效果。方法:回顾性分析2004年8月至2013年11月,连续36例主髂动脉硬化闭塞患者主股动脉旁路手术的病历资料并进行随访,将其分为开腹(AFB)组和全腹腔镜(LAFB)组。分析患者一般资料、围手术期资料和随访结果并进行两组比较。结果:36例患者平均年龄57岁,以RutherfordⅢ级和TASCⅡD级为主。AFB组23例,LAFB组13例,两组一般资料具有可比性(P>0.05)。总体手术成功率100%,围手术期病死率2.8%,并发症发生率22.2%。LAFB组手术平均时间(7.6h)长于AFB组(4.9h),术后住院天数有减少趋势(P=0.06)。总体随访时间(76±31)个月,LAFB组平均38个月,AFB组平均76个月。随访率85.7%。全组(LAFB组和AFB组)的3年一期通畅率、辅助一期通畅率、二期通畅率、保肢率和存活率分别为88.6%(90.9%和87.1%)、88.6%(90.9%和87.1%)、89.3%(90.9%和88.2%)、89.7%(91.7%和88.2%)和90.0%(92.3%和88.2%),AFB组5年上述指标分别为62.8%、63.3%、66.2%、74.7%和75.6%。两组3年随访指标无差别(P>0.05)。结论:主股动脉旁路术中远期通畅率高。全腹腔镜下主股动脉旁路术有学习曲线,中期通畅率和开腹手术无差别。

Objective： To observe the medium and long-term results of aortic femoral artery bypass by total laparoscopic and traditional open methods in a single center. Methods： A retrospective analysis of 36 consecutive patients with aorta- femoral artery bypasses from August 2004 through November 2013 was performed and the patients were followed up. The patients were divided into open surgery group（ AFB） and total laparoscopic（ LAFB） group. General data,perioperative data and follow-up results were compared between the 2groups. Results： The average age of 36 patients was 57 years old,whom classified as Rutherford grade III and TASC II D in majority. Group AFB consist of 23 cases,group LAFB 13 cases,and the general information between the 2 groups is comparable（ P〉0. 05）. The overall success rate was 100%,perioperative mortality rate2. 8%,and the complication rate 22. 2%. The average time of operation（ 7. 6h） in group LAFB was longer than that in group AFB（ 4. 9h）,and the postoperative hospital stay have a reducing tendency（ P = 0. 06）. The overall follow-up time was（ 76 ± 31） months,of which in group LAFB was 38 months,and in group AFB 76 months. Follow up rate was 85. 7%. Whole group（ group LAFB and AFB） in a period of 3 years the primary patency rate,primary assisted patency rate,secondary patency rate,limb salvage and survival rate were 88. 6%（ 90. 9% and 87. 1%）,88. 6%（ 90. 9% and 87. 1%）,89. 3%（ 90. 9% and 88. 2%）,89. 7%（ 91. 7% and88. 2%） and 90. 0%（ 92. 3% and 88. 2%） respectively. Above indexes in a period of 5 years in group AFB was 62. 8%,63. 3%,66. 2%,74. 7% and 75. 6% respectively. There was no difference between the 2 groups in 3 years indexes（ P〈0. 05）. Conclusion： Medium-long term patency rate is high in aorta-femoral artery bypass grafting. There is a learning curve about total laparoscopic aorta-femoral artery bypass manipulation. There was no difference between the total laparoscopic manipulation and open surgery in medium term patency rate.