旁路转流术治疗下肢动脉闭塞症104例临床分析

目的 总结104例下肢动脉闭塞症人工血管或自体大隐静脉旁路转流术的治疗经验。方法 回顾性分析1995～2006年对104例下肢动脉闭塞症实施的113次动脉旁路转流术的临床资料,其中腹主-双侧髂股动脉人工血管旁路15例（3例联合实施腰交感神经切断术）,腋-双股动脉人工血管旁路4例,髂-股动脉人工血管旁路25例次,股-腘动脉旁路40例次,股-股动脉人工血管旁路25例次,腘-胫后动脉旁路4例次。结果 10例切口皮缘坏死致愈合延迟,5例术后出现肢体坏疽行截肢术,其余病人术后恢复良好。踝肱指数由术前0.30±0.09增至0.77±0.09（t=3.787,P〈0.01）。结论 动脉粥样硬化短段、局限病变以介入方法 治疗为首选,长段闭塞或多节段闭塞的病变以手术治疗为主,并应正确选择流入道、流出道及血管代用品。

CLINICAL ANALYSIS OF BYPASS IN THE TREATMENT OF PATIENTS WITH ARTERIAL OCCLUSION OF LOWER EXTREMITIES： A REPORT OF 104 CASES

Objective To summarize the experience in the treatment of patients with lower extremity occlusion using vascular prosthesis or autologous great saphenous vein. Methods The data of 104 patients were reviewed retrospectively. The operative modalities included arota double iliae or double femoral artery bypass grafting with vascular prosthesis in 15 cases （three with lumbar sympatheetomy）, axillary double femoral with vascular prosthesis in four, iliae femoral with vascular prosthesis in 25, femoral popliteal in 40, femoral femoral with vascular prosthesis in 25, and popliteal posterior tibial in four. Results Delayed healing due to incision necrosis was recorded in 10 patients, amputation was done in five due to gangrene, and the rest recovered well. ABI increased from 0.30±0.09 to 0.77±0.09 （t= 3. 787, P〈0.01）. Conclusion Catheter interventional therapy is the best choice for the short and localized lesions, while surgery for a long and plurisegmental, the inflow and out flow tract and vessel substitutes should be correctly selected.