锁骨下动脉盗血综合征腔内治疗和手术治疗效果的临床分析

Endovascular management versus open surgery for subclavian steal syndrome

目的 对比分析腔内治疗和传统动脉旁路手术治疗锁骨下动脉盗血综合征（subclavian steal syndrome,SSS）的临床疗效与安全性.方法 回顾性分析2005年7月至2014年7月我院112例SSS患者的病例资料.72例采用腔内治疗;40例采用传统动脉旁路手术治疗.结果 腔内组与手术组的手术成功率（95.8％比100％,P=0.239）、术后锁骨下动脉内径[（8.3±1.6） mm比（8.1±0.7）mm,P=0.374]、术后患/健侧收缩压比[（0.95±0.12）比（0.96 ±0.15）,P=0.518],差异无统计学意义.腔内组与手术组在死亡率[0（0％）比3（7.5％）,P=0.018]、术后肾功能不全[2（2.8％）比5（12.5％）,P =0.042]、伤口感染[1（1.4％）比4（10％）,P=0.034]、手术时间[（1.5±0.32）h比（2.7±0.51）h,P=0.027]、住院天数[（5.7±3）d比（9.3±3）d,P=0.013]等方面比较,差异有统计学意义.术后随访：2组患者术后1、3、5年的锁骨下动脉通畅率、锁骨下动脉内径、患/健侧收缩压比,P ＞0.05,差异无统计学意义.结论 腔内治疗SSS安全、有效,且具有微创、并发症少、手术时间以及住院时间短等优点.

Objective To evaluate the therapeutic effects and safety of open surgery vs.endovascular procedures for subclavian steal syndrome （SSS）.Methods A retrospective analysis was made on 112 patients from July 2005 to July 2014 including 72 undergoing endovascular therapy and 40 cases treated by open bypass surgery.Results There were not difference between endovascular therapy group and surgical group in technical success rate （95.8% vs.100%,P =0.239）,postoperative subclavian artery diameter [（8.3 ± 1.6） mm vs.（8.1 ± 0.7） mm,P =0.374],postoperative suffering/contralateral systolic pressure ratio [（0.95 ±0.12） vs.（0.96 ±0.15）,P =0.518].Nor there were the differences in mortality [0（0%） vs.3 （7.5%）,P =0.018],postoperative renal dysfunction [2 （2.8%） vs.5 （12.5%）,P =0.042],wound inffections [1 （1.4%） vs.4 （10%）,P=0.034],duration of operation [（1.5 ±0.32） h vs.（2.7±0.51） h,P=0.027],days in hospital [（5.7±3） dvs.（9.3±3） d,P=0.013].After 1,3,5 years postoperative follow-up the two groups were not significantly different in patency rates,subclavian artery diameter,suffering/contralateral systolic pressure ratio （all P 〉 0.05）.Conclusion For subclavian artery steal syndrome,endovascular treatment is safe,effective and minimally invasive.