一期动静脉转流术在广泛性下肢动脉缺血循环重建中的应用

目的 探讨一期动静脉转流治疗广泛性下肢动脉缺血性病变的手术方式与临床疗效。方法 1995年10月～2005年10月，采用一期动静脉转流手术治疗下肢缺血性病变90例（肢），其中下肢广泛性动脉硬化闭塞症62例，血栓闭塞性脉管炎28例。通过回顾性分析临床资料和术后随访，总结分析一期动静脉转流手术方式的选择与临床疗效。结果 90例（肢）患者中，88例术后缺血症状明显改善，患肢疼痛消失或明显减轻．皮肤温度较术前普遍升高1～2C，手术治疗总有效率为97．7％（88／90）。2例手术失败。其中1例术后2周行膝上截肢，1例术后1周行膝下截肢。72例获术后随访，中位随访时间3．8年。其中8例患者术后5年内再次接受大网膜移植或截肢术，其余64例患者下肢缺血症状消失，生活质量明显改善。结论对于无条件实施动脉旁路术的广泛性下肢动脉缺血患者，一期动静脉转流术可迅速再建缺血下肢的血液循环，临床疗效较满意，是一种有效的治疗方式。

APPLICATION OF ONE-STAGE ARTERIOVENOUS SHUNT TO CIRCULATION RECONSTRUCTION FOR EXTENSIVE ARTERIAL ISCHEMIC DISEASE OF LOWER EXTREMITIES

Objective To investigate the clinical effect of the one-stage arteriovenous shunt on the extensive arterial ischemic disease of the lower extremities.Methods The one-stage arteriovenous shunts in the lower extremities were applied to 90 patients with extensive arterial ischemic diseases,including arterial occlusive disease(AODs,62 patients) and thromboangiitis obliterans(TAOs,28 patients).By the retrospective analysis on the clinical materials and the follow-up of the postoperative patients,the immediate and the long-term surgical outcomes were summarized.Results During the hospitalization,88 patients achieved a remarkable surgical effectiveness,with an immediate surgical effectiveness rate of 97.7%(88/90),but 2 patients failed in the operation and had to undergo amputation of the lower limb.Of the 72 patients who were followed up for 0.5-5 years after the arteriovenous shunt operation,64 could have a sufficient blood supply to the lower extremities,with a long-term effectiveness rate of 88.9%(64/72);however,8 patients had to undergo transplantation of the greater omentum or amputation of the lower limb.Conclusion The one-stage arteriovenous shunt performed on the lower extremities for an extensive arterial ischemic disease is a simpler and more effective surgical protocol for reconstruction of the circulation of the patient who is not suitable for the operation of arterial bypass.