腔内治疗锁骨下动脉盗血综合征的临床研究

发布时间：2018-06-04 16:30

本文选题：锁骨下动脉盗血综合征 + 腔内治疗　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的：对比分析腔内治疗和传统手术方式治疗锁骨下动脉盗血综合征(Subclavian steal syndrome,SSS)的临床疗效与安全性。方法：回顾性分析2005年7月至2013年1月我院112例SSS患者的病例资料。采用腔内治疗的72例,作为实验组；40例接受传统动脉旁路手术治疗,作为对照组。我们分组对112例病例进行了回顾性分析,收集患者术前、术中和术后的相关临床资料,内容包括：1、术前临床资料：年龄、性别、高血压病史、冠心病病史、糖尿病病史、吸烟史、患/健侧肱动脉收缩压比等。2、术中及术后临床资料：手术时间、住院天数、术前患/健侧肱动脉收缩压比、术后患/健侧肱动脉收缩压比、围手术期并发症(如肾功能不全、死亡等)。3、随访数据。结果：术前两组患者在性别(男/女腔内组：43/29,旁路组：24/16)、年龄(腔内组：67.3岁,旁路组：65.8岁)、高血压病史(腔内组：28例,旁路组：17例)、冠心病史(腔内组：15例,旁路组：8例)、糖尿病史(腔内组：21例,旁路组：13例)、血脂异常(腔内组：47例,旁路组：28例)、吸烟史(腔内组：57例,旁路组：32例)、患/健侧收缩压比(腔内组：0.60±0.11,旁路组：0.57±0.12)、锁骨下动脉内径(腔内组：2.1±1.1mm,旁路组：2.3±0.9mm)方面,无明显的统计学差别(P0.05)。术后两组患者在患/健侧收缩压比上,腔内组：0.95±0.12,旁路组：0.96±0.15,P0.05,无明显的统计学差别。但是腔内介入治疗组和传统外科旁路术组在手术时间(腔内组：1.5±0.32,旁路组：2.7±0.51)和住院天数(腔内组：5.7±3,旁路组：9.3±3)方面则存在明显的统计学差别(P0.05)。尤其是在围手术期并发症方面比较,死亡病例,腔内组0例(0%),旁路组3例(7.5%),P0.05；术后肾功能不全者,腔内组：2例(2.8%),旁路组：5例(12.5%),P0.05；伤口感染方面,腔内组：1例(1.4%),旁路组：4例(10%),P0.05。说明腔内组在围手术期并发症方面明显优于旁路组。术后随访6-60个月,腔内介入治疗SSS与传统外科手术近中期通畅率无明显差异(P0.05)。结论：腔内介入治疗SSS与传统外科手术相比,在治疗效果、近中期通畅率等方面无明显差异。但是腔内介入治疗在围手术期并发症方面明显低于传统动脉旁路术,手术时间以及住院时间也明显少于传统动脉旁路术。同时,腔内介入治疗具有微创的特点,避免全身麻醉的风险,有利于患者术后的体质恢复,为那些全身状况较差的SsS患者提供了治疗机会。
[Abstract]:Objective: to compare the clinical efficacy and safety of endovascular treatment and traditional surgical treatment for subclavian steal syndrome. Methods: the data of 112 cases of SSS in our hospital from July 2005 to January 2013 were analyzed retrospectively. 72 cases were treated by endovascular therapy, 40 cases were treated by traditional arterial bypass surgery as experimental group, and as control group. We divided 112 cases into two groups. We collected the clinical data of the patients before, during and after operation, including 1: 1, including age, sex, history of hypertension, history of coronary heart disease, history of diabetes mellitus, age, sex, history of hypertension, history of coronary heart disease, history of diabetes mellitus. History of smoking, systolic blood pressure ratio of brachial artery to normal side, etc. 2. Intraoperative and postoperative clinical data: operation time, length of stay, preoperative / healthy brachial artery systolic pressure ratio, postoperative / healthy brachial artery systolic pressure ratio, etc. Perioperative complications (such as renal insufficiency, death, etc.), follow-up data. Results: before operation, the two groups had sex (male / female intracavitary group: 30 / 29, bypass group: 24 / 16), age (intracavitary group: 67.3 years, bypass group: 65.8 years old), history of hypertension (intracavitary group: 28 cases, bypass group: 17 cases), coronary heart disease history (intracavitary group: 15 cases). Bypass group: 8 cases, diabetes history (intracavitary group: 21 cases, bypass group: 13 cases), dyslipidemia (intracavitary group: 47 cases, bypass group: 28 cases), history of smoking (intracavitary group: 57 cases). In the bypass group, there was no significant difference in systolic blood pressure ratio between the two groups (1: 0. 60 卤0. 11 in the intracavitary group, 0. 57 卤0. 12 in the bypass group, and 2. 1 卤1. 1 mm in the intracavitary group and 2. 3 卤0. 9 mm in the bypass group). There was no significant difference between the two groups in the ratio of systolic blood pressure (SBP) between the two groups. The ratio of the systolic blood pressure in the intracavitary group was 0.95 卤0.12, and that in the bypass group was 0.96 卤0.15 P0.05. there was no significant difference between the two groups. However, there were significant differences in the operative time (1. 5 卤0. 32 in the intracavitary group, 7. 7 卤0. 51 in the bypass group) and in the hospital stay (5. 7 卤3 in the intracavitary group and 9. 3 卤3 in the bypass group), but there was a significant difference between the two groups in the operation time (1. 5 卤0. 32 in the intracavitary group, in the bypass group). Especially in perioperative complications, death cases, intracavitary group (n = 0), bypass group (n = 3), bypass group (n = 3, P 0.05), renal insufficiency group (n = 2), intracavitary group (n = 2), bypass group (n = 5), P 0.05, wound infection group (n = 1, n = 1) and bypass group (n = 4, P 0.05). The results showed that endovascular group was superior to bypass group in perioperative complications. Follow-up for 6 to 60 months showed that there was no significant difference in patency rate between intracavitary interventional therapy (SSS) and traditional surgical procedures (P 0.05). Conclusion: there is no significant difference in therapeutic effect and patency rate between SSS and traditional surgery. However, the complications of endovascular therapy were significantly lower than that of traditional arterial bypass surgery, and the operative time and hospital stay were significantly less than that of traditional arterial bypass surgery. At the same time, intracavitary interventional therapy has the characteristics of minimally invasive, avoiding the risk of general anesthesia, which is beneficial to the recovery of the patient's physique after operation, and provides the treatment opportunity for those patients with SsS who are in poor general condition.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.3

【参考文献】