重症下肢缺血性疾病的腔内治疗

发布时间：2018-07-08 12:46

本文选题：重症下肢缺血 + 腔内治疗　；参考：《兰州大学》2015年硕士论文

【摘要】：背景重症下肢缺血(Critical limb ischemia CLI)是指由下肢动脉硬化、闭塞等病变引起严重血供不足导致的肢体缺血性静息痛和组织损害。长期血液供应不足导致严重肢体缺血,并掀起一系列病理生理反应,最终导致静息痛或腿部的营养性病变,或者二者均发生。因此,CLI被认为是“终末期”的外周动脉疾病(Peripheral arterial disease PAD)。尽管目前针对CLI的治疗方法很多,但临床研究发现CLI的1年的肢体保存率仅5%,死亡率可达25%。腔内治疗具有微创性、可重复性的特点,对于高龄、基础疾病较多、传统手术耐受力较差的CLI患者,可明显降低围手术期的死亡率及并发症的发生率。随着腔内治疗技术及材料的不断发展,腔内治疗的临床应用不断增加,其发展前景一片大好。目的探讨与分析重症下肢缺血的腔内治疗效果及其临床价值,提高下肢重症缺血性疾病的治疗成功率。方法回顾性分析兰大二院血管外科2011年9月～2014年9月住院的确诊为重症下肢缺血并行血管腔内治疗的患者32例共35条患肢的详细临床资料和相关随访资料。评估分析术前术后临床症状改善、ABI值变化及CTA影像学改变,观察术后即时效果、住院期间临床疗效、有无并发症、ABI值的变化。随访6-24个月,观察血管再通情况及患者下肢缺血症状改善状况。结果髂动脉的开通率及支架植入的成功率为100%,股胭动脉的球囊扩张及支架植入的成功率为100%,膝下动脉的球囊扩张成功率为81.2%。术后患者症状改善,患者即感下肢皮温增高,静息痛缓解或消失,溃疡逐渐愈合。围手术期截肢3例,截肢率为8.9%。患者术后平均ABI为0.70,与术前相比有显著性差异(P0.05)。随访期间死亡率7.1%,截肢率3.5%,溃疡复发率7.1%,再狭窄率21.4%。结论血管腔内技术是治疗重症下肢缺血安全有效的方式。由于该疾病仍具有较高的致残率,依然需要进一步研究。
[Abstract]:Background critical limb ischemia are ischemic resting pain and tissue damage caused by severe insufficiency of blood supply caused by arteriosclerosis and occlusion of lower extremity. Chronic insufficient blood supply leads to severe limb ischemia and a series of pathophysiological reactions leading to resting pain or nutritional lesions in the legs or both. Therefore, the peripheral arterial disease pad is considered to be the "end stage" of the disease. Although there are many treatments for CLI, clinical studies have found that the one-year limb retention rate of CLI is only 5 and the mortality rate can reach 25. Endovascular treatment has the characteristics of minimally invasive and reproducible. For CLI patients with advanced age, more basic diseases and poor tolerance of traditional surgery, the mortality rate and the incidence of complications in perioperative period can be significantly reduced. With the development of endovascular treatment technology and materials, the clinical application of intracavitary therapy is increasing. Objective to explore and analyze the effect and clinical value of endovascular treatment of severe lower extremity ischemia, and to improve the success rate of treatment of severe ischemic disease of lower extremity. Methods from September 2011 to September 2014, 32 patients with severe lower extremity ischemia and endovascular treatment were analyzed retrospectively. The detailed clinical data and related follow-up data of 35 affected limbs were analyzed. To evaluate and analyze the changes of ABI value and CTA imaging changes before and after operation, to observe the immediate effect, the clinical effect during hospitalization, and the change of ABI value in patients with complications. Patients were followed up for 6-24 months to observe the recanalization of blood vessels and the improvement of ischemic symptoms of lower extremities. Results the opening rate of iliac artery and the success rate of stent implantation were 100. The success rate of balloon dilation and stent implantation of popliteal artery was 100. The success rate of balloon dilatation of inferior genu artery was 81.2. The symptoms of the patients were improved, the skin temperature of the lower extremity was increased, the resting pain was relieved or disappeared, and the ulcer healed gradually. The amputation rate was 8.9% in 3 cases of perioperative amputation. The average postoperative ABI was 0.70, which was significantly different from that before operation (P0.05). During the follow-up period, the mortality was 7.1 and the amputation rate was 3.5. The ulcer recurrence rate was 7.1 and the restenosis rate was 21.4. Conclusion Endovascular technique is a safe and effective method for the treatment of severe lower limb ischemia. As the disease still has a high rate of disability, it still needs further study.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.3

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