老年下肢动脉硬化闭塞症诊疗的临床分析

发布时间：2018-03-29 23:20

本文选题：老年下肢动脉硬化闭塞症　切入点：诊断　出处：《福建医科大学》2015年硕士论文

【摘要】：目的:探讨老年下肢动脉硬化闭塞症的诊断与治疗。方法:回顾性分析和探讨我院血管外科2010.1—2014.6诊疗的160例≥60岁老年下肢动脉硬化闭塞症(ASO)患者的临床资料。所有ASO患者临床表现主要包括下肢凉麻、无力、间歇性跛行、静息痛及溃疡、坏疽等,每例患者入院前一般先行彩色超声多普勒进行初步检查,进而选择CTA进一步明确血管整体情况,若上述检查仍不能明确血管病变再行DSA检查。本组160例患者,其中有130例患者选择血管腔内介入手术治疗,4例患者选择旁路移植手术治疗,7例患者选择杂交手术治疗,1例患者选择静脉动脉化手术治疗,16例患者选择药物保守治疗,2例选择小腿中下段截肢手术。结果:行腔内介入手术治疗130例,127例获得成功,技术成功率为97.7%,108例获得随访,随访时间1-54个月,平均20.40±7.22个月,踝/肱指数(ABI)由术前的0.49±0.26增至0.78±0.23(P0.01),术后6、12、24个月一期通畅率为86.5%(90/104)、79.5%(58/73)、66.7%(26/39),二期通畅率为90.4%(94/104)、87.6%(64/73)、79.5%(31/39)。行下肢动脉旁路移植术4例,4例均获得随访,随访时间6-48个月,平均34.50±19.82个月,患者术后恢复良好,踝/肱指数(ABI)由术前的0.50±0.09增至0.84±0.14(P0.05)。行杂交手术治疗7例,5例获得随访,随访时间6-43个月,平均17.00±12.36个月,5例患者术后恢复良好,踝/肱指数(ABI)由术前的0.38±0.30增至0.62±0.14(P0.05)。行下肢静脉动脉化手术手术治疗1例,随访时间48个月,患者术后恢复良好。行药物保守治疗16例,5例获得随访,随访时间1-48月,平均9.0±16.69个月,5例患者症状无明显变化。行小腿中下段截肢手术治疗2例。结论:老年ASO患者年龄大且多伴发基础疾病,手术风险大,因而在围手术期处理时更应重视全身状况的改善;ASO的诊断主要靠临床表现和影像学检查,其中DSA是诊断ASO的金标准,术前一般选择彩色超声多普勒、CTA明确血管病变;ASO的治疗方法常用的有介入治疗、旁路移植手术、杂交手术、静脉动脉化及药物治疗,要结合患者血管病变程度和全身情况综合考虑,选择适合病人的方法。其中,介入治疗具有安全、微创、操作便捷的优点,疗效满意,更适合老年ASO患者。
[Abstract]:Objective: to investigate the diagnosis and treatment of arteriosclerosis obliterans of lower extremities in the elderly. Methods: the clinical data of 160 patients with ASO of lower extremity arteriosclerotic obliteration over 60 years old in our hospital from January to April 2010 were retrospectively analyzed and discussed. The clinical manifestations of patients with ASO include lower extremity anesthesia, Weakness, intermittent claudication, resting pain and ulcers, gangrene, etc., before admission, each patient was generally examined by color Doppler sonography, and then CTA was selected to further determine the overall condition of the blood vessel. If the above examination is still unable to confirm the vascular disease, the DSA examination is performed again in this group of 160 patients, Among them, 130 patients chose endovascular interventional surgery, 4 patients chose bypass grafting, 7 patients chose hybrid surgery, 1 patient chose venous arterialization surgery, 16 patients chose drug conservation. Two patients were treated with middle and lower leg amputation. Results: 130 cases (127 cases) were successfully treated by intraluminal interventional surgery. The technical success rate was 97.7% and 108 cases were followed up for 1-54 months (mean 20.40 卤7.22 months). The malleolus / brachial index was increased from 0.49 卤0.26 to 0.78 卤0.23 P0.01a, and the patency rate was 86.50.90 / 109.5C / 66.70.39 in the first trimester of 24 months after operation. The patency rate of the second stage was 90.494 / 87.67.67.67.67.67.64 / 79.5p / 31390.The follow-up time was 6-48 months (mean 34.50 卤19.82 months), and the follow-up time was 6 to 48 months (mean 34.50 卤19.82 months), and 4 patients with lower limb artery bypass grafting were followed up for 6 to 48 months, with an average of 34.50 卤19.82 months. The malleolus / brachial index was increased from 0.50 卤0.09 to 0.84 卤0.14 P0.050.The follow-up time was 6-43 months (mean 17.00 卤12.36 months). The ankle / brachial index (ABI) was increased from 0.38 卤0.30 to 0.62 卤0.14 P0.050.The patients were followed up for 48 months and 1 case was followed up for 1-48 months. There was no significant change in symptoms in 5 patients with ASO in average of 9.0 卤16.69 months. Two patients were treated with middle and lower leg amputation. Conclusion: the elderly patients with ASO are older and more complicated with underlying diseases, and the risk of operation is high. Therefore, in the perioperative period, we should pay more attention to the improvement of systemic condition. The diagnosis of ASO mainly depends on clinical manifestation and imaging examination, in which DSA is the golden standard for the diagnosis of ASO. Before operation, color Doppler echocardiography (CTA) for the determination of vascular lesions and ASO were commonly used, such as interventional therapy, bypass grafting, hybrid surgery, venous arterialization and drug therapy. We should consider the degree of vascular lesion and the whole body condition, and choose the suitable method for the patients. The interventional therapy has the advantages of safety, minimally invasive, convenient operation, satisfactory curative effect, and is more suitable for the elderly patients with ASO.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.4

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