【摘要】：目的:初步探討下肢血栓閉塞性脈管炎的影像學(xué)分型及臨床意義方法:回顧性分析新疆維吾爾族自治區(qū)人民醫(yī)院血管外科2006年1月~2014年1月下肢血栓閉塞性脈管炎84例患者影像及臨床資料,其中54例行血管重建術(shù),13例行自體大隱靜脈搭橋術(shù)[其中4例行髂股動脈搭橋術(shù)、4例行膝上股乆動脈搭橋術(shù),5例為膝下動脈搭橋術(shù)(3例為脛前動脈、2例為脛后動脈)],14例行球囊擴張術(shù)聯(lián)合置管溶栓術(shù)(髂股段1例、股乆段8例、膝下段5例),4例行球囊擴張聯(lián)合支架置入術(shù)(髂股段2例、股乆段2例),23例行動脈切開取栓術(shù)聯(lián)合干細胞移植術(shù)(髂股段2例、股乆段8例、膝下段13例)。結(jié)果:影像資料示大致分為髂股型、股乆型、膝下型。38例手術(shù)效果基本滿意,16例手術(shù)無效,分別為4例行自體大隱靜脈搭橋術(shù)、1例行球囊擴張聯(lián)合支架置入術(shù)、4例行球囊擴張聯(lián)合置管溶栓術(shù)、7例行動脈切開取栓術(shù)聯(lián)合干細胞移植術(shù)。圍手術(shù)期2例行膝上截肢術(shù),3例行膝下截肢術(shù),11例行截趾術(shù)。隨訪3月至40月,平均(16+12)月�？傮w手術(shù)成功率70.4%,術(shù)后6個月通暢率50%(24/48),12個月通暢率64.6%(31/48)。結(jié)論:根據(jù)臨床影像資料分析,我們大致將下肢血栓閉塞性脈管炎分為三型,即髂股型、股乆型、膝下型,其中髂股型少見,大多有良好遠端流出道。股乆型、膝下型常見,閉塞平面下多無良好遠端流出道。因此根據(jù)患者的血管情況選擇不同的術(shù)式,對于有良好遠端流出道的患者,首選自體大隱靜脈搭橋術(shù),無良好遠端流出道的患者可選擇球囊擴張術(shù),療效尚可。對于慢性患者急性血栓形成的患者動脈切開取栓聯(lián)合干細胞移植是一種可行、有效的方法。
[Abstract]:Objective: to study the imaging classification and clinical significance of thromboocclusive vasculitis of lower extremity: retrospective analysis of vascular occlusion of lower extremity thrombosis in Xinjiang Uygur Autonomous region people's Hospital from January 2006 to January 2014 Imaging and clinical data of 84 patients with inflammation, Of these, 54 underwent revascularization, 13 major saphenous vein autograft [4 iliofemoral artery bypass grafting, 4 superior genicular femoral artery bypass grafting, 5 inferior genicular artery bypass grafting (3 anterior tibial artery and 2 posterior tibial artery bypass grafting) 14 cases underwent balloon dilatation combined with catheter thrombolysis (1 case of iliofemoral segment). There were 8 cases of femoral segment, 5 cases of lower genu segment, 4 cases of balloon dilation combined with stent implantation (2 cases of iliofemoral segment, 2 cases of femoral segment), 23 cases of artery incision and embolization combined with stem cell transplantation (2 cases of iliofemoral segment, 8 cases of femoral segment and 13 cases of lower genu segment). Results: the imaging data showed that there were three types: iliofemoral type, femoral type, subgenu type, 38 cases were satisfactory, 16 cases were ineffective. There were 4 cases of autologous saphenous vein bypass grafting, 1 case of balloon dilatation combined with stent implantation, 4 cases of balloon dilation combined with catheter thrombolysis, and 7 cases of artery incision and embolization combined with stem cell transplantation. During the perioperative period, 2 cases were treated with superior knee amputation, 3 cases with subknee amputation, and 11 cases with toe amputation. The follow-up ranged from 3 months to 40 months, with an average of 16 12 months. The overall success rate of operation was 70.4. The patency rate was 50% (24 / 48) at 6 months postoperatively and 64.6% (31 / 48) at 12 months. Conclusion: according to the analysis of clinical imaging data, we divide the thrombosis obliterative vasculitis of lower extremity into three types, namely, iliofemoral type, femoral type and subgenu type, among which iliofemoral type is rare, and most of them have good distal outflow tract. There is no good distal outflow tract under obliterated plane. Therefore according to the blood vessel condition of the patients choose different operation methods for patients with good distal outflow the first choice is autologous saphenous vein bypass surgery without good distal flow out of the patients can choose balloon dilatation the curative effect is good. It is a feasible and effective method for patients with chronic acute thrombosis.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.3

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