【摘要】：背景下肢動脈硬化閉塞癥是全身動脈硬化病變的重要組成部分,以髂-股動脈及股-胭動脈等大中動脈最易受累,后期多累及胭動脈遠端的動脈,病變類型及程度均較復(fù)雜。針對股胭動脈以及累計遠端動脈的慢性閉塞性復(fù)雜病變,根據(jù)TASCⅡ分級,傳統(tǒng)上傾向于行開發(fā)性手術(shù)治療,然而目前的臨床實踐上已納入腔內(nèi)介入治療范圍。因此在股胭動脈分型的復(fù)雜下肢動脈硬化閉塞癥上,應(yīng)用腔內(nèi)血管成形術(shù)治療的適應(yīng)證仍未完善。目的探討下肢動脈硬化閉塞癥股胭動脈分型的復(fù)雜病變,結(jié)合不同類型病變應(yīng)用腔內(nèi)血管成形術(shù)治療的適應(yīng)證和療效分析。方法采用回顧性對照分析的方法,收集我院于2011年1月至2014年10月收治的42例行腔內(nèi)血管成形術(shù)治療的復(fù)雜下肢動脈硬化閉塞癥患者。病例術(shù)前影像學(xué)表現(xiàn)為股胭動脈分型TASCⅡ C或D級,臨床表現(xiàn)符合Fontaine較重的Ⅱ期,以及Ⅲ、Ⅳ期,分析各風(fēng)險因素。術(shù)后觀察手術(shù)成功率,住院期間并發(fā)癥發(fā)生率。對比手術(shù)前后患肢踝肱指數(shù)(ABI)變化情況,并進行t檢驗。所有病例術(shù)后進行門診檢查或電話詢問方式隨訪3-18個月,對臨床癥狀改善情況進行分析,觀察中短期術(shù)后通暢率。結(jié)果所有42例患者行腔內(nèi)血管成形術(shù),手術(shù)成功率為92.8%,住院期間并發(fā)癥發(fā)生率為19%。術(shù)后1周患者ABI較術(shù)前有顯著性差異。42例患者術(shù)后隨訪3-18個月,大部分患者的臨床癥狀得到改善,中短期通暢率為88%。結(jié)論1.在掌握腔內(nèi)治療復(fù)雜下肢動脈硬化閉塞癥的適應(yīng)證的前提下,應(yīng)用腔內(nèi)血管成形術(shù)可作為推薦的治療方案。對于傳統(tǒng)上適合或者不適合行開放性手術(shù)治療的復(fù)雜下肢動脈硬化閉塞癥患者,應(yīng)用腔內(nèi)治療均可作為一種安全有效的治療手段。2.目前的TASCⅡ分級標準已經(jīng)對下肢動脈閉塞性病變的分類診斷作出了詳細描述,但是股胭動脈的慢性閉塞性復(fù)雜病變的分類仍有待完善。同時綜合影像學(xué)特征以及臨床癥狀的表現(xiàn),才能掌握腔內(nèi)治療的適應(yīng)證,并有針對性的選擇腔內(nèi)血管成形術(shù)的手術(shù)方式。3.腔內(nèi)介入治療的手術(shù)成功率高,并發(fā)癥少,短-中期術(shù)后通暢率滿意。此類復(fù)雜性病變的中長期治療效果仍需進一步觀察。
[Abstract]:In the background, limb arteriosclerosis obliteration is an important part of systemic arteriosclerosis. Iliofemoral artery and middle thigh artery are the most easily involved, and the distal artery of carmine artery is more involved in the later stage, and the type and degree of lesion are more complex. According to TASC II grade, the patients with chronic occlusive complex lesions of popliteal artery and cumulative distal artery are traditionally inclined to be treated by developmental surgery, but the current clinical practice has been included in the scope of intracavitary interventional therapy. Therefore, the indication of endovascular angioplasty is still not perfect in the complex arteriosclerosis obliteration of lower extremity in the classification of popliteal artery. Objective to investigate the complex lesions of femoral popliteal artery classification in patients with arteriosclerosis obliterans of lower extremity, and to analyze the indication and curative effect of endovascular angioplasty combined with different types of lesions. Methods from January 2011 to October 2014, 42 patients with complex arteriosclerosis obliterans of lower extremity treated with endovascular angioplasty were collected by retrospective comparative analysis. The preoperative imaging findings of the cases were TASC 鈪，

本文編號：2504444