發(fā)布時(shí)間：2018-06-04 16:30

  本文選題：鎖骨下動(dòng)脈盜血綜合征 + 腔內(nèi)治療　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：對(duì)比分析腔內(nèi)治療和傳統(tǒng)手術(shù)方式治療鎖骨下動(dòng)脈盜血綜合征(Subclavian steal syndrome,SSS)的臨床療效與安全性。 方法：回顧性分析2005年7月至2013年1月我院112例SSS患者的病例資料。采用腔內(nèi)治療的72例,作為實(shí)驗(yàn)組；40例接受傳統(tǒng)動(dòng)脈旁路手術(shù)治療,作為對(duì)照組。 我們分組對(duì)112例病例進(jìn)行了回顧性分析,收集患者術(shù)前、術(shù)中和術(shù)后的相關(guān)臨床資料,內(nèi)容包括：1、術(shù)前臨床資料：年齡、性別、高血壓病史、冠心病病史、糖尿病病史、吸煙史、患/健側(cè)肱動(dòng)脈收縮壓比等。2、術(shù)中及術(shù)后臨床資料：手術(shù)時(shí)間、住院天數(shù)、術(shù)前患/健側(cè)肱動(dòng)脈收縮壓比、術(shù)后患/健側(cè)肱動(dòng)脈收縮壓比、圍手術(shù)期并發(fā)癥(如腎功能不全、死亡等)。3、隨訪(fǎng)數(shù)據(jù)。 結(jié)果：術(shù)前兩組患者在性別(男/女腔內(nèi)組：43/29,旁路組：24/16)、年齡(腔內(nèi)組：67.3歲,旁路組：65.8歲)、高血壓病史(腔內(nèi)組：28例,旁路組：17例)、冠心病史(腔內(nèi)組：15例,旁路組：8例)、糖尿病史(腔內(nèi)組：21例,旁路組：13例)、血脂異常(腔內(nèi)組：47例,旁路組：28例)、吸煙史(腔內(nèi)組：57例,旁路組：32例)、患/健側(cè)收縮壓比(腔內(nèi)組：0.60±0.11,旁路組：0.57±0.12)、鎖骨下動(dòng)脈內(nèi)徑(腔內(nèi)組：2.1±1.1mm,旁路組：2.3±0.9mm)方面,無(wú)明顯的統(tǒng)計(jì)學(xué)差別(P0.05)。 術(shù)后兩組患者在患/健側(cè)收縮壓比上,腔內(nèi)組：0.95±0.12,旁路組：0.96±0.15,P0.05,無(wú)明顯的統(tǒng)計(jì)學(xué)差別。但是腔內(nèi)介入治療組和傳統(tǒng)外科旁路術(shù)組在手術(shù)時(shí)間(腔內(nèi)組：1.5±0.32,旁路組：2.7±0.51)和住院天數(shù)(腔內(nèi)組：5.7±3,旁路組：9.3±3)方面則存在明顯的統(tǒng)計(jì)學(xué)差別(P0.05)。尤其是在圍手術(shù)期并發(fā)癥方面比較,死亡病例,腔內(nèi)組0例(0%),旁路組3例(7.5%),P0.05；術(shù)后腎功能不全者,腔內(nèi)組：2例(2.8%),旁路組：5例(12.5%),P0.05；傷口感染方面,腔內(nèi)組：1例(1.4%),旁路組：4例(10%),P0.05。說(shuō)明腔內(nèi)組在圍手術(shù)期并發(fā)癥方面明顯優(yōu)于旁路組。 術(shù)后隨訪(fǎng)6-60個(gè)月,腔內(nèi)介入治療SSS與傳統(tǒng)外科手術(shù)近中期通暢率無(wú)明顯差異(P0.05)。 結(jié)論：腔內(nèi)介入治療SSS與傳統(tǒng)外科手術(shù)相比,在治療效果、近中期通暢率等方面無(wú)明顯差異。但是腔內(nèi)介入治療在圍手術(shù)期并發(fā)癥方面明顯低于傳統(tǒng)動(dòng)脈旁路術(shù),手術(shù)時(shí)間以及住院時(shí)間也明顯少于傳統(tǒng)動(dòng)脈旁路術(shù)。同時(shí),腔內(nèi)介入治療具有微創(chuàng)的特點(diǎn),避免全身麻醉的風(fēng)險(xiǎn),有利于患者術(shù)后的體質(zhì)恢復(fù),為那些全身狀況較差的SsS患者提供了治療機(jī)會(huì)。
[Abstract]:Objective: to compare the clinical efficacy and safety of endovascular treatment and traditional surgical treatment for subclavian steal syndrome. Methods: the data of 112 cases of SSS in our hospital from July 2005 to January 2013 were analyzed retrospectively. 72 cases were treated by endovascular therapy, 40 cases were treated by traditional arterial bypass surgery as experimental group, and as control group. We divided 112 cases into two groups. We collected the clinical data of the patients before, during and after operation, including 1: 1, including age, sex, history of hypertension, history of coronary heart disease, history of diabetes mellitus, age, sex, history of hypertension, history of coronary heart disease, history of diabetes mellitus. History of smoking, systolic blood pressure ratio of brachial artery to normal side, etc. 2. Intraoperative and postoperative clinical data: operation time, length of stay, preoperative / healthy brachial artery systolic pressure ratio, postoperative / healthy brachial artery systolic pressure ratio, etc. Perioperative complications (such as renal insufficiency, death, etc.), follow-up data. Results: before operation, the two groups had sex (male / female intracavitary group: 30 / 29, bypass group: 24 / 16), age (intracavitary group: 67.3 years, bypass group: 65.8 years old), history of hypertension (intracavitary group: 28 cases, bypass group: 17 cases), coronary heart disease history (intracavitary group: 15 cases). Bypass group: 8 cases, diabetes history (intracavitary group: 21 cases, bypass group: 13 cases), dyslipidemia (intracavitary group: 47 cases, bypass group: 28 cases), history of smoking (intracavitary group: 57 cases). In the bypass group, there was no significant difference in systolic blood pressure ratio between the two groups (1: 0. 60 鹵0. 11 in the intracavitary group, 0. 57 鹵0. 12 in the bypass group, and 2. 1 鹵1. 1 mm in the intracavitary group and 2. 3 鹵0. 9 mm in the bypass group). There was no significant difference between the two groups in the ratio of systolic blood pressure (SBP) between the two groups. The ratio of the systolic blood pressure in the intracavitary group was 0.95 鹵0.12, and that in the bypass group was 0.96 鹵0.15 P0.05. there was no significant difference between the two groups. However, there were significant differences in the operative time (1. 5 鹵0. 32 in the intracavitary group, 7. 7 鹵0. 51 in the bypass group) and in the hospital stay (5. 7 鹵3 in the intracavitary group and 9. 3 鹵3 in the bypass group), but there was a significant difference between the two groups in the operation time (1. 5 鹵0. 32 in the intracavitary group, in the bypass group). Especially in perioperative complications, death cases, intracavitary group (n = 0), bypass group (n = 3), bypass group (n = 3, P 0.05), renal insufficiency group (n = 2), intracavitary group (n = 2), bypass group (n = 5), P 0.05, wound infection group (n = 1, n = 1) and bypass group (n = 4, P 0.05). The results showed that endovascular group was superior to bypass group in perioperative complications. Follow-up for 6 to 60 months showed that there was no significant difference in patency rate between intracavitary interventional therapy (SSS) and traditional surgical procedures (P 0.05). Conclusion: there is no significant difference in therapeutic effect and patency rate between SSS and traditional surgery. However, the complications of endovascular therapy were significantly lower than that of traditional arterial bypass surgery, and the operative time and hospital stay were significantly less than that of traditional arterial bypass surgery. At the same time, intracavitary interventional therapy has the characteristics of minimally invasive, avoiding the risk of general anesthesia, which is beneficial to the recovery of the patient's physique after operation, and provides the treatment opportunity for those patients with SsS who are in poor general condition.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R654.3

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