动脉硬化性主髂动脉闭塞症血管重建的术式选择

目的分析解剖位和非解剖位术式对动脉硬化性主髂动脉闭塞的手术疗效、围手术期死亡和主要并发症的影响。方法对动脉硬化性主髂动脉闭塞症行主髂动脉重建术的382例患者的30d围手术期疗效、死亡和并发症的危险因素采用Logistic回归进行分析。结果共126名患者纳入分析。Logistic逐步回归显示手术有效率的影响因素有溃疡坏死（OR0．13，95％CI0．33～0．36，P=0．005）、是否同期远端血管重建（OR11．29，95％CI1．25～102．53，P=0．012）；围手术期主要并发症为13．5％，危险因素有年龄（OR37．13，95％CI3．29～48．53，P=0．003）、肾功能异常（OR5．71，95％CI1．25～25．02，P=0．024）、Goldman心脏风险（OR26．83，95％CI4．85～49．54，P=0．001）、术式选择（OR0．03，95％CI0．002～0．34，P=0．005）；围手术期死亡的危险因素有年龄（OR65．56，95％CI4．88～87．64，P=0．002）、Goldman心脏风险（OR23．86，95％CI3．90～45．99，P=0．032）、术式选择（OR0．02，95％CI0．001—0．262，P：0．005）。结论年龄70岁以上、中度以上Goldman心脏风险、肾功能异常是围手术期死亡和主要并发症的危险因素，对于这些高危患者需考虑采用解剖外术式以降低手术风险。

Surgical reconstruction for atherosclerosic aortoiliac occlusion

Objective To evaluate the effects of anatomic and extra-anatomic reconstruction in cases of aortoiliac occlusion on perioperative morbidity and mortality. Methods Clinical data of 382 cases were retrospectively analyzed with reference to perioperative morbidity and mortality by Logistic regression. Results One hundred and twenty- six patients were enrolled into analysis. Impact factors included lower extremities necrosis(OR 0. 13 95% CI 0. 33 - 0. 36,P=0.005), simultaneous distal reconstruction (OR 11.29 95% CI 1.25 - 102.53,P =0.012). Perioperative complications developed in 13. 5% cases. Goldman cardiac risk(OR 26. 83 95% CI 4. 85 - 49. 54,P =0. 001),age (OR 37. 13 95% CI 3. 29 -48. 53,P = 0. 003),renal dysfunction(OR 5. 71 95% CI 1. 25 -25. 02, P = 0. 024) and surgical modality (OR 0. 03 95% CI 0. 002 - 0. 34, P =0. 005) were identified as risk factors. Perioperative mortality was 8. 7%. Goldman cardiac risk (OR 23. 86 95% CI 3. 90 - 45. 99,P =0. 032),age(OR 65. 56 95% CI 4.88-87.64, P =0.002) and surgical modality(OR 0.02 95% CI 0. 001 -0.262, P=0.005) were among factors predicting perioperative death. Conclusions Age over 70 years, renal dysfunction, intermediate or higher Goldman cardiac risk, moderate or severe emphysema are risk factors of perioperative mortality and morbitity of aortoiliac reconstruction. Extra-anatomic reconstruction should be considered against the risk factors in poor risk patients.