复合术式治疗复杂型下肢动脉硬化闭塞症疗效分析及其影响因素的研究

目的探讨复合术式(球囊扩张、支架植入联合内膜剥脱及取栓)治疗复杂型下肢动脉硬化闭塞症(ASO)的远期疗效及其相关影响因素。方法回顾性分析2005年1月至2009年11月间,复合术式(球囊扩张+支架置入、内膜剥脱+介入、导管取栓+介入)治疗318例ASO患者的临床资料,其中糖尿病性下肢动脉硬化闭塞症(DASO)198例(61例为双侧病变)259侧肢体,非糖尿病性下肢动脉硬化闭塞症(NDASO)120例(41例为双侧病变)161侧肢体。随访6～36个月,分析患者腘动脉以下血管及股浅动脉的通畅率及其相关影响因素。结果 318例患者中首次治疗成功率分别为DASO腘动脉以下血管90%,股浅动脉血管92%,NDASO腘动脉以下血管91%,股浅动脉血管94%,随访6～36个月,DASO腘动脉以下血管通畅率明显低于NDASO腘动脉以下血管通畅率。DASO腘动脉以下血管累积二次通畅率为89%～67%,股浅动脉血管累积二次通畅率为93%～73%。支架植入组的狭窄率显著低于非支架植入组(P0.05)。DASO的血管的通畅率减低与吸烟史、高血压、血糖控制不稳等因素有关。无围术期死亡及严重并发症发生。结论复合术式治疗下肢动脉硬化闭塞症适应范围广泛,疗法肯定。控制相关影响因素,可有效提高疗效。

Study of the effect and influencing factors of complex operation for intractable lower extremity arterial occlusive disease

0bjective To evaluate the effect and influencing factors after undergoing complex operation through balloon angioplasty,endovascular stent implantation（stenting）combined with endarterectomy and throm bectomy in lower extremity arterial occlusive disease.Methods From January 2005 to November 2009,318 patients＇clinical data were retrospectively studied after the patients undergoing the double femoral artery cente-sis balloon angioplasty and endovascular stent implantation（stenting）or endarterectomy and endovascular repair or thrombectomy and endovascular repair to cure lower extremity arterial occlusive disease,including 198 with DLASO（61 with bilateral lesions）259 side extremity,120 with LEAOD（41 with bilateral lesions）161 side ex-tremity.Follow-up was 6 to 36 months,the correlation factors and patency rate of popliteal artery following vascu-lar（primary vascular）and superficial femoral artery（secondary vascular）were analyzed.Results A total of 318 patients in the initial success rate was DLASO 90% with primary vascular,92%with secondary vascular;LEAOD 91% with primary vascular,94% with secondary vascular respectively.Mean follow-up 6 to 36 months,the pri-mary patency in patients with DLASO was significantly lower than patiences with LEAOD.The accumulated（to-tal）secondary patency for primary vascular was 89%-67%,for secondary vascular was 93%-73% respectively.The restenosis rates in the two groups with stenting was significantly lower then those with non-stenting,P0.05.Multivariate logistic regression analysis on univariate analysis showed that reduced patency rates in DLASO were related to tobacco use（any）history,hypertension and many other factors.No patients with perioperative death and serious complications.Conclusions There are satisfactory results about the use of complex operation for lower extremity arterial occlusive disease.The clinical effect will be improved,if the influencing factors under control effectively.