下肢动脉旁路转流术后阻塞再手术的初步体会

目的总结下肢动脉旁路转流术后阻塞再手术的临床经验。方法回顾性分析1996年5月至2004年2月间19例（20条）下肢动脉旁路转流术后阻塞共31次再手术患者的治疗效果。结果18次单纯转流血管取栓术后通畅时间1d至3年，通畅率为27．7％（5／18），再阻塞率为72．3％（13／18）；13次取栓加流入或流出道旁路重建术后通畅时间4d至11个月，通畅率为61．5％（8／13），再阻塞率为38．5％（5／13）。全组再手术总通畅率41．9％（13／31），平均通畅时间8．1个月（3—29个月）；手术死亡率5．3％（1／19），肢体存活率73．7％（14／19），截肢率25％（5／20）。结论术后晚期发生转流血管再阻塞的最主要原因是内膜增生和病变进展；取栓加流人或流出道重建旁路术的效果优于单纯取栓术；加强术后彩超随访，及时修正增生性病变，将有助于提高转流血管通畅率。

The effect of re-operation on postoperative arterial bypass occlusion in lower limbs

Objective To review the experiences of re-operational effect for occluded arterial bypass in lower limbs. Method We analyzed the re-operational effect of 19 patients (20 limbs) with occluded arterial bypass in lower limbs from May 1996 to Fab 2004. A total of 31 operations were performed in these patients. Results The patent rate of simple thrombectomy in 18 cases was only 27.7% (5/18) with a rate of re-obstruction of 72. 3%(13/18). The period of patent outflow of another 13 re-operations with rebuilt of in-flow or out-flow varied at 4 days to 11 months. The patent rate in this group was 61.5% (8/13). The rate of re-obstruction was 38. 5% (5/13). The overall patent rate of re-operation was 41.9% (13/31). The average patent period was 9. 1 months (3-29 m). The operative mortality rate in 19 patients was 5. 3% (1/19). The limb salvage rate of 19 limbs in 18 patients was 73. 7%(14/19). The amputation rate was 25%(5/20). Conclusion The main cause of late re-obstruction of bypass procedure was endothelial proliferation and development of lesions. The effect of rebuilt of in-flow or out-flow was better than thrombectomy only. Duplex follow-up helps to find restenoses and manage the proliferated lesions before a bypass becomes occluded.