本文選題：老年下肢動脈硬化閉塞癥　切入點(diǎn)：診斷　出處：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討老年下肢動脈硬化閉塞癥的診斷與治療。方法:回顧性分析和探討我院血管外科2010.1—2014.6診療的160例≥60歲老年下肢動脈硬化閉塞癥(ASO)患者的臨床資料。所有ASO患者臨床表現(xiàn)主要包括下肢涼麻、無力、間歇性跛行、靜息痛及潰瘍、壞疽等,每例患者入院前一般先行彩色超聲多普勒進(jìn)行初步檢查,進(jìn)而選擇CTA進(jìn)一步明確血管整體情況,若上述檢查仍不能明確血管病變再行DSA檢查。本組160例患者,其中有130例患者選擇血管腔內(nèi)介入手術(shù)治療,4例患者選擇旁路移植手術(shù)治療,7例患者選擇雜交手術(shù)治療,1例患者選擇靜脈動脈化手術(shù)治療,16例患者選擇藥物保守治療,2例選擇小腿中下段截肢手術(shù)。結(jié)果:行腔內(nèi)介入手術(shù)治療130例,127例獲得成功,技術(shù)成功率為97.7%,108例獲得隨訪,隨訪時間1-54個月,平均20.40±7.22個月,踝/肱指數(shù)(ABI)由術(shù)前的0.49±0.26增至0.78±0.23(P0.01),術(shù)后6、12、24個月一期通暢率為86.5%(90/104)、79.5%(58/73)、66.7%(26/39),二期通暢率為90.4%(94/104)、87.6%(64/73)、79.5%(31/39)。行下肢動脈旁路移植術(shù)4例,4例均獲得隨訪,隨訪時間6-48個月,平均34.50±19.82個月,患者術(shù)后恢復(fù)良好,踝/肱指數(shù)(ABI)由術(shù)前的0.50±0.09增至0.84±0.14(P0.05)。行雜交手術(shù)治療7例,5例獲得隨訪,隨訪時間6-43個月,平均17.00±12.36個月,5例患者術(shù)后恢復(fù)良好,踝/肱指數(shù)(ABI)由術(shù)前的0.38±0.30增至0.62±0.14(P0.05)。行下肢靜脈動脈化手術(shù)手術(shù)治療1例,隨訪時間48個月,患者術(shù)后恢復(fù)良好。行藥物保守治療16例,5例獲得隨訪,隨訪時間1-48月,平均9.0±16.69個月,5例患者癥狀無明顯變化。行小腿中下段截肢手術(shù)治療2例。結(jié)論:老年ASO患者年齡大且多伴發(fā)基礎(chǔ)疾病,手術(shù)風(fēng)險大,因而在圍手術(shù)期處理時更應(yīng)重視全身狀況的改善;ASO的診斷主要靠臨床表現(xiàn)和影像學(xué)檢查,其中DSA是診斷ASO的金標(biāo)準(zhǔn),術(shù)前一般選擇彩色超聲多普勒、CTA明確血管病變;ASO的治療方法常用的有介入治療、旁路移植手術(shù)、雜交手術(shù)、靜脈動脈化及藥物治療,要結(jié)合患者血管病變程度和全身情況綜合考慮,選擇適合病人的方法。其中,介入治療具有安全、微創(chuàng)、操作便捷的優(yōu)點(diǎn),療效滿意,更適合老年ASO患者。
[Abstract]:Objective: to investigate the diagnosis and treatment of arteriosclerosis obliterans of lower extremities in the elderly. Methods: the clinical data of 160 patients with ASO of lower extremity arteriosclerotic obliteration over 60 years old in our hospital from January to April 2010 were retrospectively analyzed and discussed. The clinical manifestations of patients with ASO include lower extremity anesthesia, Weakness, intermittent claudication, resting pain and ulcers, gangrene, etc., before admission, each patient was generally examined by color Doppler sonography, and then CTA was selected to further determine the overall condition of the blood vessel. If the above examination is still unable to confirm the vascular disease, the DSA examination is performed again in this group of 160 patients, Among them, 130 patients chose endovascular interventional surgery, 4 patients chose bypass grafting, 7 patients chose hybrid surgery, 1 patient chose venous arterialization surgery, 16 patients chose drug conservation. Two patients were treated with middle and lower leg amputation. Results: 130 cases (127 cases) were successfully treated by intraluminal interventional surgery. The technical success rate was 97.7% and 108 cases were followed up for 1-54 months (mean 20.40 鹵7.22 months). The malleolus / brachial index was increased from 0.49 鹵0.26 to 0.78 鹵0.23 P0.01a, and the patency rate was 86.50.90 / 109.5C / 66.70.39 in the first trimester of 24 months after operation. The patency rate of the second stage was 90.494 / 87.67.67.67.67.67.64 / 79.5p / 31390.The follow-up time was 6-48 months (mean 34.50 鹵19.82 months), and the follow-up time was 6 to 48 months (mean 34.50 鹵19.82 months), and 4 patients with lower limb artery bypass grafting were followed up for 6 to 48 months, with an average of 34.50 鹵19.82 months. The malleolus / brachial index was increased from 0.50 鹵0.09 to 0.84 鹵0.14 P0.050.The follow-up time was 6-43 months (mean 17.00 鹵12.36 months). The ankle / brachial index (ABI) was increased from 0.38 鹵0.30 to 0.62 鹵0.14 P0.050.The patients were followed up for 48 months and 1 case was followed up for 1-48 months. There was no significant change in symptoms in 5 patients with ASO in average of 9.0 鹵16.69 months. Two patients were treated with middle and lower leg amputation. Conclusion: the elderly patients with ASO are older and more complicated with underlying diseases, and the risk of operation is high. Therefore, in the perioperative period, we should pay more attention to the improvement of systemic condition. The diagnosis of ASO mainly depends on clinical manifestation and imaging examination, in which DSA is the golden standard for the diagnosis of ASO. Before operation, color Doppler echocardiography (CTA) for the determination of vascular lesions and ASO were commonly used, such as interventional therapy, bypass grafting, hybrid surgery, venous arterialization and drug therapy. We should consider the degree of vascular lesion and the whole body condition, and choose the suitable method for the patients. The interventional therapy has the advantages of safety, minimally invasive, convenient operation, satisfactory curative effect, and is more suitable for the elderly patients with ASO.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.4

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