TASCC/D型主髂动脉硬化闭塞症的杂交手术治疗

Hybrid therapy for TASC C/D aortoiliac arteriosclerosis obliterans

目的:评价杂交手术治疗TASC C/D型主髂动脉硬化闭塞症的临床疗效。方法:回顾性分析2012年5月—2014年5月采用杂交手术治疗的48例TASC C/D型主髂动脉硬化闭塞症患者(共66条患肢)临床资料,其中TASC C型22例,D型26例,观察围手术期情况,比较不同Fontaine分级患者血管再通情况并分析影响一期通畅率的因素。结果:48例(66条患肢)杂交手术均获得成功,手术成功率100%,1例患者因下肢坏疽处感染严重而于术后5 d行截肢手术,无死亡病例,围手术期并发症发生率16.67%。与术前比较,术后间歇性跛行距离(568 m vs.92 m)与踝肱指数(0.75 vs.0.25)均明显增加(均P<0.05)。平均随访24个月,术后6个月和1、2年的一期通畅率分别为95.45%、90.91%、87.88%,二期通畅率分别为98.48%、96.97%、92.42%;Fontaine II、III级患者一期通畅率均高于IV级患者(P=0.036、0.015),而II、III级患者之间一期通畅率无统计学差异(P>0.05);高脂血症和糖尿病是影响术后一期通畅率的独立危险因素(P=0.026、0.003)。结论:杂交手术是治疗TASC C/D型主髂动脉硬化闭塞症的安全、有效方式。

Objective：To evaluate the clinical effcacy of hybrid therapy for TASC C/D aortoiliac arteriosclerosis obliterans. Methods：hTe clinical data of 48 patients （66 limbs） with TASC C/D （including TASC C in 22 cases and TASC D in 26 cases） aortoiliac arteriosclerosis occlusive diseases undergoing hybrid revascularization procedures from May 2012 to May 2014 were analyzed. hTe perioperative conditions were evaluated, the revascularization results among patients with different Fontaine classiifcations were compared, and the inlfuential factors for primary patency were analyzed. Results：hTe hybrid procedures were successfully performed in all 48 patients （66 limbs）, and technical success rate was 100%. One patient underwent amputation on postoperative day 5 due to severe gangrene and infection of the lower limb, but no death occurred and the incidence of perioperative complications was 16.67%. The postoperative distance of intermittent claudication （568 m vs. 92 m） and ankle-brachial index （0.75 vs. 0.25） were signiifcantly higher than those before operation （both P〈0.05）. hTe average period of follow-up was 24 months,the 6-month and 1-and 2-year primary patency rate was 95.45%, 90.91%and 87.88%, and secondary patency rate was 98.48%, 96.97%and 92.42%, respectively. hTe primary patency rate in patients with Fontaine stage II and III were signiifcantly higher than that in patients with Fontaine stage IV （P=0.036, 0.015）, which however had no statistical difference between patients with Fontaine stage II and III （P〉0.05）. hTe presence of diabetes and dyslipidaemia were independent risk factors for decreased primary patency （P=0.026, 0.003）. Conclusion：Hybrid therapy is a safe and effective treatment for TASC C/D aortoiliac arteriosclerosis obliterans.