本文選題：重癥下肢缺血 + 腔內(nèi)治療��； 參考：《蘭州大學(xué)》2015年碩士論文

【摘要】：背景重癥下肢缺血(Critical limb ischemia CLI)是指由下肢動(dòng)脈硬化、閉塞等病變引起嚴(yán)重血供不足導(dǎo)致的肢體缺血性靜息痛和組織損害。長期血液供應(yīng)不足導(dǎo)致嚴(yán)重肢體缺血,并掀起一系列病理生理反應(yīng),最終導(dǎo)致靜息痛或腿部的營養(yǎng)性病變,或者二者均發(fā)生。因此,CLI被認(rèn)為是“終末期”的外周動(dòng)脈疾病(Peripheral arterial disease PAD)。盡管目前針對CLI的治療方法很多,但臨床研究發(fā)現(xiàn)CLI的1年的肢體保存率僅5%,死亡率可達(dá)25%。腔內(nèi)治療具有微創(chuàng)性、可重復(fù)性的特點(diǎn),對于高齡、基礎(chǔ)疾病較多、傳統(tǒng)手術(shù)耐受力較差的CLI患者,可明顯降低圍手術(shù)期的死亡率及并發(fā)癥的發(fā)生率。隨著腔內(nèi)治療技術(shù)及材料的不斷發(fā)展,腔內(nèi)治療的臨床應(yīng)用不斷增加,其發(fā)展前景一片大好。目的探討與分析重癥下肢缺血的腔內(nèi)治療效果及其臨床價(jià)值,提高下肢重癥缺血性疾病的治療成功率。方法回顧性分析蘭大二院血管外科2011年9月～2014年9月住院的確診為重癥下肢缺血并行血管腔內(nèi)治療的患者32例共35條患肢的詳細(xì)臨床資料和相關(guān)隨訪資料。評(píng)估分析術(shù)前術(shù)后臨床癥狀改善、ABI值變化及CTA影像學(xué)改變,觀察術(shù)后即時(shí)效果、住院期間臨床療效、有無并發(fā)癥、ABI值的變化。隨訪6-24個(gè)月,觀察血管再通情況及患者下肢缺血癥狀改善狀況。結(jié)果 髂動(dòng)脈的開通率及支架植入的成功率為100%,股胭動(dòng)脈的球囊擴(kuò)張及支架植入的成功率為100%,膝下動(dòng)脈的球囊擴(kuò)張成功率為81.2%。術(shù)后患者癥狀改善,患者即感下肢皮溫增高,靜息痛緩解或消失,潰瘍逐漸愈合。圍手術(shù)期截肢3例,截肢率為8.9%�；颊咝g(shù)后平均ABI為0.70,與術(shù)前相比有顯著性差異(P0.05)。隨訪期間死亡率7.1%,截肢率3.5%,潰瘍復(fù)發(fā)率7.1%,再狹窄率21.4%。結(jié)論血管腔內(nèi)技術(shù)是治療重癥下肢缺血安全有效的方式。由于該疾病仍具有較高的致殘率,依然需要進(jìn)一步研究。
[Abstract]:Background critical limb ischemia are ischemic resting pain and tissue damage caused by severe insufficiency of blood supply caused by arteriosclerosis and occlusion of lower extremity. Chronic insufficient blood supply leads to severe limb ischemia and a series of pathophysiological reactions leading to resting pain or nutritional lesions in the legs or both. Therefore, the peripheral arterial disease pad is considered to be the "end stage" of the disease. Although there are many treatments for CLI, clinical studies have found that the one-year limb retention rate of CLI is only 5 and the mortality rate can reach 25. Endovascular treatment has the characteristics of minimally invasive and reproducible. For CLI patients with advanced age, more basic diseases and poor tolerance of traditional surgery, the mortality rate and the incidence of complications in perioperative period can be significantly reduced. With the development of endovascular treatment technology and materials, the clinical application of intracavitary therapy is increasing. Objective to explore and analyze the effect and clinical value of endovascular treatment of severe lower extremity ischemia, and to improve the success rate of treatment of severe ischemic disease of lower extremity. Methods from September 2011 to September 2014, 32 patients with severe lower extremity ischemia and endovascular treatment were analyzed retrospectively. The detailed clinical data and related follow-up data of 35 affected limbs were analyzed. To evaluate and analyze the changes of ABI value and CTA imaging changes before and after operation, to observe the immediate effect, the clinical effect during hospitalization, and the change of ABI value in patients with complications. Patients were followed up for 6-24 months to observe the recanalization of blood vessels and the improvement of ischemic symptoms of lower extremities. Results the opening rate of iliac artery and the success rate of stent implantation were 100. The success rate of balloon dilation and stent implantation of popliteal artery was 100. The success rate of balloon dilatation of inferior genu artery was 81.2. The symptoms of the patients were improved, the skin temperature of the lower extremity was increased, the resting pain was relieved or disappeared, and the ulcer healed gradually. The amputation rate was 8.9% in 3 cases of perioperative amputation. The average postoperative ABI was 0.70, which was significantly different from that before operation (P0.05). During the follow-up period, the mortality was 7.1 and the amputation rate was 3.5. The ulcer recurrence rate was 7.1 and the restenosis rate was 21.4. Conclusion Endovascular technique is a safe and effective method for the treatment of severe lower limb ischemia. As the disease still has a high rate of disability, it still needs further study.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R658.3

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相關(guān)期刊論文 前2條

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本文編號(hào)：2107478