股总动脉内膜剥脱术后再狭窄的影响因素

Influencing factors of restenosis after common femoral artery endarterectomy

目的探讨股总动脉硬化闭塞症患者行股总动脉内膜剥脱术后发生再狭窄的相关影响因素。方法回顾性分析2011年1月至2019年9月于首都医科大学宣武医院血管外科行股总动脉内膜剥脱术的136例患者为研究对象,术后下肢动脉超声检查评估股总动脉再狭窄>70%纳入再狭窄组(n=47),股总动脉再狭窄≤70%纳入通畅组(n=89)。比较股总动脉通畅组和再狭窄组患者的临床资料,使用Cox比例风险回归模型探索股总动脉内膜剥脱术后再狭窄的影响因素。采用SPSS 21.0统计软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。结果136例患者术后发生再狭窄47例(34.6%)。股总动脉通畅组和再狭窄组患者合并糖尿病、吸烟情况和低密度脂蛋白胆固醇比较,差异均有统计学意义[30(63.8%)和35(39.3%),29(61.7%)和29(32.6%),(1.79±0.58)和(1.54±0.46)mmol/L;均P<0.05]。2组患者膝下流出道情况比较,差异有统计学意义(P<0.05)。2组患者均于术后1 d各发生腹股沟血肿1例,于术后3 d各发生局部淋巴漏1例,给予对症处理后均痊愈。Cox比例风险回归模型分析后显示:合并糖尿病(RR=2.339,95%CI 1.273~4.296,P=0.006)、吸烟史(RR=1.931,95%CI 1.063~3.507,P=0.031)及膝下流出道情况(RR=0.412,95%CI 0.217~0.783,P=0.007)和股总动脉内膜剥脱术后发生再狭窄独立相关。结论患者合并糖尿病、吸烟史是影响股总动脉内膜剥脱术预后的独立危险因素,积极处理膝下流出道可能会降低股总动脉内膜剥脱术后再狭窄的发生率。

Objective To investigate the related factors influencing restenosis after common femoral artery endarterectomy(CFAE)in treatment of arteriosclerosis obliterans at common femoral artery(CFA).Methods A total of 136 patients with arteriosclerosis obliterans at CFA who underwent CFAE in our hospital from January 2011 to September 2019 were retrospectively subjected in this study.The patients with restenosis of common femoral artery>70%were included in the restenosis group(n=47),and those of restenosis≤70%in the patency group(n=89).The clinical data were compared between the 2 groups.Cox proportional hazards regression model was used to analyze the influencing factor for restenosis after endarterectomy.SPSS statistics 21.0 was used for statis-tical analysis.Data comparison between 2 groups was performed using student′s t test or Chi-square test depending on data type.Results Forty-seven of 136 patients(34.6%)suffered from restenosis.There were significant differences in proportions of diabetes and smoking history and level of low-density lipoprotein cholesterol between the patency group and the restenosis group[30(63.8%)vs 35(39.3%),29(61.7%)vs 29(32.6%),(1.79±0.58)vs(1.54±0.46)mmol/L,all P<0.05].Obvious difference was seen in the situation of below-the-knee run-offs between the 2 groups(P<0.05).In both groups,1 case of inguinal hematoma occurred in 1 d after operation and 1 case of local lymphatic leakage occurred in 3 d after operation.All patients were cured after symptomatic treat-ment.Results of Cox proportional hazard model showed that diabetes mellitus(RR=2.339,95%CI 1.273-4.296,P=0.006),smok-ing history(RR=1.931,95%CI 1.063-3.507,P=0.031)and below-the-knee run-offs(RR=0.412,95%CI 0.217-0.783,P=0.007)were independently related with restenosis after CFAE.Conclusion Comorbidity of diabetes mellitus and smoking history are independent risk factors of restenosis in patients after CFAE.Initiative management of below-the-knee run-offs may reduce the incidence of restenosis.