下肢动脉硬化闭塞症支架植入术后再狭窄治疗方法的对比研究

Comparative study of restenosis therapy after stent implantation for arteriosclerosis obliterans of lower extremities

目的观察下肢动脉硬化闭塞症(ASO)支架植入术后再狭窄的各种治疗方法的疗效,讨论支架后再狭窄的预防和治疗。方法纳入2014年6月至2017年5月在南京鼓楼医院治疗ASO支架植入术后再狭窄闭塞的患者77例(107条肢体),分为开放手术20条,复合手术12条,血管腔内成形术56条,基因药物治疗3条,截肢16条。术后再狭窄闭塞发生的时间为术后0.5~48个月,平均12.27个月。结果术后随访69例,随访率88.23%。随访时间3~24个月,平均12.2个月。随访期间出现支架内再狭窄39例,发生率为56.52%,术后3、6个月各组治疗效果比较差异无统计学意义(P>0.05)。术后12个月,各组治疗效果有区别,差异有统计学意义(P=0.049)。术后24个月,各组治疗效果有显著区别,其中外科手术旁路术组的再狭窄率最低(15.00%),单纯球囊扩张组的再狭窄率最高(78.57%)。结论临床治疗中应根据每个再狭窄患者的具体情况定制个体化治疗方案,尽量避免过多支架植入。必要时应配合开放手术,术后予以正规药物治疗。

Objective To observe the efficacy of various treatment methods of restenosis after stent implantation for arteriosclerosis obliterans（ ASO） of lower extremities, and to discuss the prevention and treatment of restenosis after stent implantation. Method A total of 77 patients（107 limbs） with restenosis after lower limb artery stent implantation in Drum Tower Hospital of Nanjing from June 2014 to May 2017 were divided into open surgery（20 cases）, hybridization（12 cases）, intravascular 56 cases of angioplasty,3 cases of gene therapy, amputation in 16 cases. The duration of postoperative restenosis occlusion was 0.5-48 months postoperatively with an average of 12.27 months. Results 69 patients were followed up, the follow-up rate was 88.23%. Follow-up time of 3 to 24 months, an average of 12.2 months. There were 39 cases of stent restenosis during follow-up, the incidence rate was 56.52%. There was no significant difference between the two groups at 3 months and 6 months after operation（P〈0.05）. After 12 months,there was a difference between the groups in the treatment effect, the difference was statistically significant（P =0.049）. At 24 months after operation, there was a significant difference between the two groups. The restenosis rate was the lowest in surgical bypass surgery group（15.00%） and the highest in restenosis group（78.57%） in balloon-only group. Conclusions In clinical treatment, individualized treatment plans should be tailored to the specific circumstances of each patient. In the treatment of primary disease, we must also be careful treatment of repeated endovascular treatment. Try to avoid excessive stent implantation. When necessary, should be accompanied by open surgery, postoperative formal drug treatment.