影响股浅动脉硬化闭塞症外科治疗预后的相关因素

目的 明确股胴动脉病变TASCⅡ分级、流出道评分、影响动脉硬化危险因素与外科治疗股浅动脉硬化闭塞症术后疗效的相关性.方法 回顾性分析2006年1月至2009年9月北京同仁医院对股胭动脉硬化闭塞症行股胭动脉段介入或手术治疗142例患者的临床资料.采用TASCⅡ分级标准对股胴动脉段病变分级;使用流出道评分标准对胫腓动脉进行膝下流出道评分.随访患者术后疗效,用Kaplan-Meier法计算一期通畅率,用COX回归分析病变TASCⅡ分级、流出道评分、各种动脉硬化危险因素与术后一期通畅率相关性.结果 本组142例(197条患肢).其中外科手术治疗50例(58条患肢);介入治疗99例(139条患肢).随访患者141例(196条患肢),随访率90.8%.术后随访时间1～26个月,中位随访时间13个月.经COX回归分析,术前股浅动脉病变TASCⅡ分级(RR=1.471,P=0.012)、流出道评分(RR=1.190,P=0.004)、2型糖尿病(RR=2.320,P=0.019)为影响外科治疗股浅动脉病变术后一期通畅率的因素. 结论术前TASCⅡ分级级别较高、流出道评分分值较高及患有2型糖尿病的患者,股浅动脉病变术后一期通畅率不佳.

Factors influencing postoperative prognosis in superficial femoral artery occlusive disease

Objective The purpose of this study is to determine whether the TransAtlantic InterSociety Consensus (TASC) criteria (Ⅱ-2007 versions), the Society of Vascular Surgery (SVS) runoff score or risk factors for peripheral arterial disease were correlated with postoperative outcome of superficial femoral artery occlusive disease. Methods From January 2006 to September 2009, patients who suffered from lower extremity atherosclerosis occlusion disease and underwent endovascular or surgical therapy in superficial femoral artery segment were reviewed retrospectively at Beijing Tongren Hospital. Femoralpopliteal artery lesions were graded according to the TASC Ⅱ criteria. Runoff scores were determined in infrapopliteal artery segment lesions. All patients were followed up. Kaplan-Meier method was applied to calculate primary patency rate, and COX regression analysis was used to determine if TASC Ⅱ classification,runoff score, or factors for peripheral arterial disease affected primary patency rate. Results 142 patients (197 limbs) were followed up after treatment at 1 month, 3 months, 6 months, and every 6 months thereafter. Median follow-up time was 13 months. By Cox regression analysis, TASC Ⅱ classification(RR =1.471,P = 0. 012 ), runoff score ( RR = 1.190, P = 0. 004 ), and type 2 diabetic mellitus ( RR = 2. 320, P =0.019) significantly affected primary patency. Conclusions Postoperative poor patency rates are associated with higher degree of the TASC Ⅱ lesions, poor initial runoff score, and type 2 diabetic mellitus in patients of superfical femoral artery occlusive disease.