肾下腹主动脉闭塞症39例诊治分析

目的总结1986～2000年间我院收治的肾下腹主动脉闭塞症39例.方法回顾性分析39例肾下腹主动脉闭塞症患者.其中男31例,女8例,有27例行手术治疗.结果多数患者有间歇性跛行症状(79.4%),71%男患有阳萎症状.彩色多普勒超声、螺旋ZTA和MRA检查能够确诊.主动脉造影或DSA检查对疾病状况及手术方式的选择有帮助.手术需全面考虑患者的全身状态以及受累血管的条件.本组中13例患者行腹主-髂总动脉Y型人工血管移植术、6例行腹主-双侧股动脉旁路术、解剖外旁路5例、2例仅行Fogarty导管取栓术、另有1例行腹主动脉人工血管间置术加肾动脉成形术.腹主-髂总动脉人工血管移植术效果最好,1年通畅率100%,5年通畅率仍为75%.腋-股架桥术5年通畅率仅为37.5%.结论早期诊断、及时及全面的综合治疗是提高Leriche综合征血管移植术后远期通畅率的关键.

Analysis of diagnosis and surgical treatment of 39 cases of infrarenal aortic occlusion

Objective: To summarize the diagnosis and surgical treatment of 39 cases of infrarenal aortic occlusion, which means Leriche syndrome. Methods: A retrospective review of 39 patients with infrarenal aortic occlusion was undertaken, which included 31 males and 8 females. 27 cases were treated by surgery. Results: They mostly had claudication and impotence. Color doppler ultrasonography, especially CTA and MRA, were helpful for diagnosis. Aortic angiography or DSA was necessary for determining the clinical patterns and therapic methods. Clinically, it should be differentiated from other diseases. Ankle-brachial index was also valuable in diagnosis and prognosis. Surgical patterns, general status, and conditions of the affected vessels should be considered. Surgical treatment included 13 aortoiliac vascular bypasses, 6 aortobifemoral bypasses, 5 axillo-bifemoral bypass procedures and 1 renal artery reconstructions. Y type aorta-iliac bypasses got the best result with one-year patency rates of 100% in all cases, and 5-year patency rates of 75%, significantly superior to those axillo-bifemoral bypass grafts with patency only 37.5%. Conclusions: Early diagnosis and comprehensive therapy should be adopted to improve the long-term patency rates after grafts transplantation in Leriche syndrome.