本文選題：下肢動脈硬化閉塞癥 + 股乆動脈��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:由于目前國內(nèi)外對于股乆動脈動脈硬化閉塞癥是否一期置入支架還存在有較大爭議[1]。因此,本研究是回顧性分析我科收治的患有股乆動脈硬化閉塞疾病的患者進(jìn)行腔內(nèi)血管成形術(shù)或是支架植入術(shù)治療后的效果。并比較是否符合國內(nèi)外現(xiàn)有的臨床研究,同時(shí)深入對股乆動脈B、C及D型病變進(jìn)行兩種治療方法比較,進(jìn)一步明確分型對不同腔內(nèi)治療方法的選擇。方法:回顧分析廣西醫(yī)科大學(xué)一附院血管外科2010.09-2016.09收治的患有股乆動脈硬化閉塞疾病的患者進(jìn)行經(jīng)皮腔內(nèi)血管成形術(shù)或是支架置入術(shù)的患者共72例(77條患肢),男62例,女10例,年齡在42-101歲,平均年齡69.88±11.23歲。根據(jù)治療方式不同將其分為單純球囊擴(kuò)張組(共40例,42條肢體),球囊擴(kuò)張并支架植入組(共32例,35條肢體)。對合并有髂動脈、膝下動脈病變患者一并進(jìn)行相應(yīng)血管開通治療。并對TASCIIB/C、D型再次進(jìn)行分組比較,隨訪并記錄患者術(shù)前術(shù)后ABI、術(shù)后平均22.4±15.7個(gè)月(6-36個(gè)月)的臨床癥狀、累積通暢率、保肢率、生存率等,進(jìn)行統(tǒng)計(jì)學(xué)分析,比較二者療效如何,并根據(jù)分型所實(shí)行不同治療方法的比較,進(jìn)一步明確不同分型所應(yīng)選擇的恰當(dāng)腔內(nèi)治療方式。結(jié)果:72例(共77條患肢)當(dāng)中,成功開通病變患肢74條,技術(shù)成功率達(dá)96.1%(74/77)。圍手術(shù)期死亡率達(dá)4.2%(3/72)。主要并發(fā)癥發(fā)生率6.9%(5/72)。術(shù)后短期內(nèi)兩組患者肢體癥狀、潰瘍愈合情況及踝肱指數(shù)均有明顯改善,組內(nèi)對比差異有統(tǒng)計(jì)學(xué)意義(P0.05),組間對比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后隨訪的6月、12月、24月、36月PTA組和PTAS組的初期通暢率分別為:71.1%、81.3%,64.5%、63.0%,54.5%、57.9%,53.8%、61.5%。保肢率分別為:92.1%、96.9%,96.7%、89.3%,94.1%、93.3%,92.9%、100%。生存率分別為:90%、87.5%,84.6%、81.3%,81.3%、77.9%,81.3%、71.4%。隨訪過程中,兩組血管的通暢率、保肢率及生存率經(jīng)統(tǒng)計(jì)學(xué)分析,均無統(tǒng)計(jì)學(xué)意義(P0.05),但對B、C型進(jìn)行隨訪統(tǒng)計(jì)顯示,隨訪期內(nèi)B型兩組通暢率分別為:77.1%、65.2%,保肢率為:93.8%、88.9%。C型兩組通暢率分別為:46.3%、66.7%,保肢率為:86.7%、94.9%。B、C型的保肢率無明顯差異(P0.05)。B型通暢率二者無明顯統(tǒng)計(jì)學(xué)意義,C型通暢率二者有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:研究結(jié)果顯示,單純球囊擴(kuò)張和球囊擴(kuò)張并支架置入術(shù)治療股乆動脈硬化閉塞在近中期療效基本相近,差異無統(tǒng)計(jì)學(xué)意義,但進(jìn)一步對股乆動脈病變分型更進(jìn)一步進(jìn)行統(tǒng)計(jì)分析,A、B型病變可以單純球囊擴(kuò)張為主,C、D型病變可偏向選擇球擴(kuò)并支架置入治療。但由于樣本量較少,遠(yuǎn)期療效及分型治療選擇的臨床數(shù)據(jù)支持,還需增大樣本量及延長隨訪時(shí)間進(jìn)一步研究。
[Abstract]:Objective: whether stents are placed in one-stage stenting of femoral arteriosclerosis obliterans is still controversial at home and abroad [1].Therefore, this study is a retrospective analysis of the results of endovascular angioplasty or stent implantation in patients with femoral and arteriosclerosis occlusive diseases.At the same time, the author compared the two treatment methods for the type C and D lesions of the femoral artery, and further defined the choice of different endovascular treatment methods.Methods: a total of 72 patients (62 males and 10 females) who underwent percutaneous transluminal angioplasty or stent implantation in vascular surgery of the affiliated Hospital of Guangxi Medical University were retrospectively analyzed, including 62 males and 10 females, who had undergone percutaneous transluminal angioplasty or stenting, including 62 males and 10 females, who had undergone percutaneous transluminal angioplasty or stenting.The average age was 69.88 鹵11.23 years.According to the different treatment methods, they were divided into simple balloon dilatation group (40 cases with 42 limbs), balloon dilatation and stent implantation group (32 cases with 35 limbs).Patients with iliac artery and inferior genu artery disease were treated with vasotomization.The clinical symptoms, cumulative patency rate, limb salvage rate, survival rate and so on were compared again. The clinical symptoms, cumulative patency rate, limb salvage rate, survival rate and so on were analyzed statistically, and the curative effects of the two groups were compared by means of follow-up and recording of ABI before and after operation, with a mean of 22.4 鹵15.7 months or 6-36 months after operation.According to the comparison of different treatment methods, the proper endovascular treatment should be selected.Results Seventy-four diseased limbs were successfully opened in 72 cases (77 affected limbs), and the technical success rate was 96.1 / 74 / 77.Perioperative mortality was 4.2 / 72.The incidence of major complications was 6.9 / 72%.The symptoms, ulcer healing and ankle-brachial index of the two groups were significantly improved in a short period of time after operation. There was a significant difference in comparison between the two groups (P 0.05), but there was no significant difference between the two groups (P 0.05).The initial patency rates of the PTA group and the PTAS group at 6 months, 12 months, 24 months and 36 months after the operation were: 71.1% and 81.3%, 64.5% and 63.5% respectively.The limb salvage rate was 92.9% and 96.7% respectively, and 94.31% and 93.3%, 93.3% and 92.9% respectively.The survival rates were 87.5and 84.6and 81.3and 81.3and 77.9and 81.31.44, respectively.During the follow-up, the patency rate, limb salvage rate and survival rate of the two groups were not statistically significant (P 0.05).During the follow-up period, the patency rates of two groups of type B were 65.20.The patency rates of the two groups were: 1: 93.8and 88.9.C. the patency rates of the two groups were:: 46.3and 66.7, respectively. There was no significant difference in the rate of limb salvage between the two groups. There was no significant difference between the two groups in the patency rate of type B and the patency rate of type C; there was no significant difference in the patency rate of type C and the patency rate of type C (P 0.05).Conclusion: the results showed that the curative effect of balloon dilatation alone and balloon dilatation with stenting in treating femoral arteriosclerosis occlusion was similar in the near to middle term, but the difference was not statistically significant.But further statistical analysis was carried out on the classification of femoral arterial lesions. The patients with type B lesions could be treated with balloon dilatation and stent implantation in favor of selective balloon dilatation.However, because of the small sample size, the long-term curative effect and the clinical data of the classification treatment choice, it is necessary to increase the sample size and extend the follow-up time to further study.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.5

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