血栓闭塞性脉管炎的外科治疗

目的:评估治疗血栓闭塞性脉管炎各种外科手术方法的优缺点和适应证.方法:总结了108例外科治疗病例,其中直接动脉重建12例,大网膜移植术16例,静脉动脉化术18例,交感神经切除术72例,其中联合手术14例.结果:6例随访6月～10年,5例因疗效差而截肢,包括直接大网膜移植1例,局部神经切除术2例和腰交感神经切除2例.动脉重建联合静脉动脉化及腰交感神经切除效果最好.结论:原位大隐静脉旁路术及低位深组静脉动脉化术疗效最优,交感神经切除适合早期病变,大网膜移植术对三期患者也有疗效,联合手术互相补充,相得益彰,值得推广.

Surgical Treatment for Thromboarteritis Obliterans

Objective: One hundred and eight cases of thromboarteritis obliterans(1987~1997) were analyzed retrospectively to evaluate the results of different surgical procedures. Methods: There were 12 cases of arterial reconstructions, 16 cases of auto-omental graft, 18 cases of arterialization of the vein(AVR) and 72 cases of sympathectomies performed for critical ischaemia of the lower extremities. Concomitant procedures were carried out in 14 patients. Results: Within follow-up of 65 cases, from 6 months to 10 years, there were 5 cases of amputations which contained omental graft 1 case, local neurorectomy 2 cases and sympathectomy 2 cases. Concomitant arterial reconstruction, arterialization of vein and sym-pathectomy had the best result. Conclusions: In situ saphous vein arterial bypass and lower deep AVR appeared to be the procedures of choice in lower extremity revascularization; concomitant procedures to ensure sufficient inflow and outflow are advantageous to guarantee the patency of the graft.