复合手术治疗复杂下肢动脉硬化闭塞症的疗效评估

目的 探讨复合手术治疗多节段复杂下肢动脉硬化闭塞症（arteriosclerosis obliterans,ASO）的临床疗效.方法 回顾性分析2009年1月-2012年12月采用复合手术治疗多节段复杂下肢ASO的47例患者（均为单肢症状）.其中男性37例,女性10例.股动脉内膜切除补片成形＋逆向长段髂动脉内膜剥脱＋ stent/PTA 7例,股动脉内膜切除补片成形＋ stent/PTA（顺行、逆行）17例,股动脉内膜切除补片成形＋顺行长段股浅动脉内膜切除＋stent/PTA8例,股动脉内膜切除补片成形＋髂动脉stent/PTA＋股深动脉成形术5例,髂动脉stent＋股-股动脉人工血管移植术2例,股动脉切开取栓＋内膜剥脱补片成形/stent/PTA 8例,合并膝下动脉病变,部分予以小球囊局段扩张.以上补片为涤纶,人工血管材料为PTFE.结果 手术成功率100％,无严重并发症,踝肱指数（ankle brachial index,ABI）由术前（0.30±0.19）提高至术后（0.63 ±0.20）,下肢症状均不同程度改善,术后平均随访1年,通畅率87.2％ （41/47）,4例坏疽足趾自行脱落,6例股浅动脉支架内再狭窄.结论 复合手术（股动脉内膜切除结合腔内技术）治疗FontaineⅡ-Ⅳ期多节段复杂下肢动脉硬化闭塞症简洁微创、安全有效、中远期疗效可,尤其适合老年危重患者.

Evaluation of the clinical effect of complex operation for intractable lower ASO

Objective To study the clinical effect of complex operation for intractable lower ASO with multi-segment. Methods From January 2009 to December 2012, 47 cases were treated by complex operation, there were 37 male and 10 female, femoral artery endarterectomy with patch angioplasty ＋backward iliac arterial intima stripped＋superficial femoral artery PTA/Stent in 7 cases, femoralarteryendarterectomywithpatchangioplasty＋PTA/Stent （forward or backward） in 17 cases, femoral artery endarterectomy with patch angioplasty ＋ forward superficial femoral arterial intima stripped ＋ super- ficial femoral artery PTA/Stent in 8 cases , femoral artery endarterectomy with patch angioplasty＋iliac Stent＋extended？ profundaplasty in 5 cases, iliac Stent ＋ cross-femoral bypass grafting in 2 case, femoral artery endarterectomy with patch angioplasty ＋ artery embolectomy of Fogarty catheter/ PTA/Stent in 8 cases, combine with lesions under knee, small balloon were used. Results The technical success rate was 100%, without serious complications, The ankle brachial Index （ABI） was improved markedly from （0.30 ＋0.19） to （0.63 ＋0.20）, limb skin temperature higher than before, rest pain disappeared, intermittent claudication symptoms improved. The mean duration of follow-up was 1 year, The patency rate was 87.2% （ 41/47 ）. 4 cases with digit gangrene healing by itself, 6 restenosis in superficial femoral artery. Conclusion Complex operation （combine femoral artery endarterectomy and Endovascular technology） is sample, safe and effective, expecially for severely aged person.