下肢动脉硬化闭塞症的外科治疗

目的:探讨外科治疗下肢动脉硬化闭塞症的临床经验。方法:从1995年7月～2002年7月共对292例(313条肢体)动脉硬化闭塞症病人进行外科治疗,其中20条患肢施行解剖外血管重建术,38条患肢施行了腔内外科治疗或合并开放性血管重建手术,255条患肢施行了开放性手术重建下肢血供。结果:手术成功者患肢的踝肱指数与术前比较显著增加(P<0.01),症状得到明显改善。平均随访时间3.1年(0.5～7年),解剖外重建组移植血管一期通畅率为56%,腔内外科组通畅率为78%,开放性手术组通畅率为72%。结论:病人的全身情况、动脉病变的范围和程度是选择下肢动脉硬化闭塞症外科治疗方法的主要依据,为取得较好的长期通畅率和临床效果需要重视围手术期处理和术后随访。

Surgical treatment of arteriosclerosis occlusive disease in the lower extremity

Objective To review our experience of surgical treatments for arteriosclerosis occlusive disease in the lower extremities. Methods From July 1995 to July 2002, surgical treatments were performed on 313 lower extremities of 292 patients with arteriosclerosis occlusive disease. Of them, extra-anatomic bypass were performed in 20 lower extremities endovascular treatment combined open vascular operations in 38 and only open vascular operations in 255. Results Post-operative ankle/brachial index was significantly increased, the symptoms of critical ischemia in the extremities were ameliorated. Mean period of follow-up was 3.1 years (range 0.5 to 7 year), The primary patency rates of extra-anatomic bypass, endovascular treatment combined open vascular operations and open vascular operations were 56%, 78% and 72%, respectively. Conclusion The proper selection of surgical treatments for arteriosclerosis occlusive disease relies on the severity of the vascular disease, and perioperative treatments and follow-up for gaining good long-term patency and clinical outcomes should be done.