血栓闭塞性脉管炎外科与腔内治疗疗效研究

Surgical and endovascular treatment of thromboangiitisobliterans

目的探讨外科与腔内治疗对下肢动脉血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)的作用,为TAO的综合治疗提供循证医学依据。方法回顾性分析2006年4月至2015年4月间,哈尔滨医科大学附属第一医院采用外科或腔内治疗下肢动脉TAO的202例病人的临床资料。根据踝肱指数(ABI),Rutherford分级等指标评价各种手术方案的疗效。结果 Rutherford分级(R值)评价:术后1个月,行经皮腔内血管成型术(PTA)组、腰交感神经节切除组、序贯法内膜剥脱组、腰交感神经结节切除+序贯法内膜剥脱组病人与术前比较R值均降低(P<0.05);术后6个月,腰交感神经节切除组、序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组R值降低(P<0.05);术后12个月,序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组R值降低(P<0.05)。ABI指标:术后1周,4组病人与术前比较ABI值均升高(P<0.05);术后6个月,腰交感神经节切除+序贯法内膜剥脱组ABI值升高(P<0.05);术后12个月,序贯法内膜剥脱组、腰交感神经节切除+序贯法内膜剥脱组ABI值升高(P<0.05)。结论单纯PTA和腰交感神经节切除术使膝下远端动脉闭塞的TAO病人术后短期内获益明显。单纯序贯法内膜剥脱术或联合腰交感神经节切除术是一种治疗下肢动脉TAO明确有效的外科治疗方法。

Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliteraus. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index （ABI） and the Rutherford classification value （R-value）, the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation： One month after operation, R-value decreasedin all 4 groups （P〈0.05）. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group （P〈0.05）. Twelve months after operation, R-value decreased in sequential endartereetomy group and sequential endarterectomy combined with lumbar sympathectomy group （P〈0.05）.ABI evaluation： One week after operation,ABI increased in all 4 groups （P〈0.05）. Six mouths after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group （P〈0.05）. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group （P〈0.05）. Conclusion Percutaneous transluminal angioplasty （PTA） and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.