多节段髂股动脉闭塞症的微创治疗：附40 例报告

目的：探讨采用髂动脉支架植入术+股动脉内膜剥脱术+补片成形术治疗多节段髂股动脉硬化闭塞症的临床疗效。方法：选择2010年3月—2013年3月收治的40例多节段髂股动脉硬化闭塞症患者，均采用髂动脉支架植入术+股动脉内膜剥脱术+补片成形术治疗。结果：所有患者均手术成功，术后37例（92.5%）患者临床症状明显改善。术后间歇性跛行距离和静息下踝肱指数均明显高于术前（均P<0.05）。40例患者术后随访12~45个月，一期通畅率为70.0%（28/40）、辅助一期通畅率为82.5%（33/40）、二期通畅率为92.5%（37/40）。统计分析显示，Fontaine II级患者的一期通畅率明显高于III、IV级的患者（P=0.039，0.015），未发现术后一期通畅率的独立影响因素。结论：微创手术治疗多节段髂股动脉硬化闭塞症临床疗效显著，且应在临床症状出现的早期进行治疗，以获得更佳的一期通畅率。

Minimally invasive treatment of multisegment iliofemoral occlusion: a report of 40 cases

Objective: To investigate the clinical efficacy of iliac artery stenting plus femoral endarterectomy and patch angioplasty in treatment of multisegment iliofemoral arteriosclerosis obliterans.Methods: Forty patients with multisegment iliofemoral occlusion admitted from March 2010 to March 2013 were selected, and all of them underwent iliac artery stenting plus femoral endarterectomy and patch angioplasty.Results: Operation was successfully performed in all patients, and the clinical symptoms in 37 patients (92.5%) were significantly improved after treatment. The intermittent claudication distance and resting ankle-brachial index were significantly higher than those before operation (both P<0.05). The forty patients were followed-up for 12 to 45 months after operation; the primary patency rate was 70.0%, the assisted primary patency rate was 82.5%, and the second-stage patency rate was 92.5%, respectively. Statistical analyses showed that the primary patency rate in patients with Fontaine stage II disease was significantly higher than those with stage III and IV disease (P=0.039; 0.015), and no independent influential factor for the postoperative primary patency rate was found.Conclusion: Minimally invasive operation has demonstrable efficacy in treatment of multisegment iliofemoral arteriosclerosis obliterans, and it should be performed at the early stage of development of clinical symptoms so as to obtain the best primary patency rate.