主髂动脉重建联合股深动脉成形术治疗老年下肢缺血性疾病效果分析

Treatment of lower extremity ischemia in the elderly patients with primary iliac reconstruction coupled with angioplasty of profunda femoris artery

目的对比主髂动脉重建股浅动脉(SFA)开通术与主髂动脉重建股深动脉(PFA)成形术治疗老年下肢重症缺血患者的临床资料及疗效。方法回顾分析2016年1月至2016年12月在黑龙江省医院与黑龙江中医药大学附属第一医院就诊的老年下肢重症缺血患者64例。依据治疗方法分为2组:SFA治疗组和PFA治疗组,每组32例。对比2组患者术前术后的踝肱指数(ABI)、并发症发生率、死亡率、手术时间、住院天数、溃疡愈合天数等。采用SPSS 17.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。结果与术前相比,SFA治疗组[(0.25±0.12)vs(0.87±0.09)]和PFA治疗组[(0.23±0.11)vs(0.69±0.08)]患者术后的ABI均显著增高(P<0.05),且SFA治疗组患者术后的ABI显著高于PFA治疗组[(0.87±0.09)vs(0.69±0.08),P<0.05]。与SFA治疗组相比,PFA治疗组患者的术后并发症发生率(62.5%vs12.5%)显著减少,手术时间[(189±41)vs(130±61)min]和住院时间[(18±4)vs(10±4)d]显著缩短,但足部溃疡愈合时间[(28±5)vs(74±4)d]显著延长,差异均具有统计学意义(P<0.001)。随访1年后,SFA治疗组和PFA治疗组患者跛行距离<100 m的发生率(50.0%vs 46.9%)及截肢率(28.1%vs 25.0%)比较,差异均无统计学意义(P>0.05)。结论主髂动脉重建联合PFA成形术既可改善老年下肢缺血性疾病,又可显著降低术后并发症及截肢率,提高患者生存率及生存质量。

Objective This study aimed to compare the primary iliac reconstruction coupled with angioplasty of profunda femoris artery（ PFA） and the primary iliac reconstruction coupled with angioplasty of superficial femoral artery（ SFA） for the treatment of severe lower extremity ischemia in the elderly in the aspects of clinical data and efficacy. Methods The clinical data were reviewed of64 elderly patients with severe lower extremity ischemia treated at Heilongjiang Provincial Hospital and First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2016 to December 2016. They were divided into 2 groups： SFA group and PFA group with 32 patients each. The two groups were compared in ankle brachial index（ ABI） before and after treatment,complication rate,mortality,operation time,hospitalization days and days of ulcer healing. SPSS statistics 17. 0 was used for data analysis,and Student＇s t test or Chi-square test for different data types. Results ABI indicated significant increases of revascularization in both groups after treatment（ P 0. 05）,with SFA group being obviously greater than the PFA group（ P 0. 05）. SFA group had fewer ulcer healing days than the PFA group（ P 0. 001）. PFA group outperformed SFA group in complication rate（62. 5% vs 12.5%）,operation time [（189 ± 41） vs（130 ± 61） min] and hospitalization days [（18 ± 4） vs（10 ± 4） d,P 0. 001]. No significant differences was observed in the numbers of patients with claudication of less than 100 m（50. 0% vs 46. 9%） and amputation（28. 1% vs25. 0%） within 1 year after operation（ P 0. 05）. Conclusion The primary iliac artery reconstruction coupled with PFA angioplasty can not only alleviate lower extremity ischemia but also significantly reduce the postoperative complications and amputation rate with increased survival rate and improved life quality of the patients.