腔内支架置入与传统旁路术治疗主髂动脉闭塞的对比分析

发布时间：2018-10-05 19:01

【摘要】：目的探讨腔内支架置入术与主-双股动脉旁路术在治疗主髂动脉闭塞性疾病的适应证、技术要点、并发症、通畅率及评估其疗效。方法搜集2011年4月至2013年10月间,于我院血管外科行手术干预的主髂动脉闭塞疾病共105例,随机选取并纳入34例(41条患肢),其中间歇性跛行17例,下肢静息痛7例,合并溃疡或坏疽10例。按两种术式将其平均分为两组,对患者的术前资料、手术适应证、手术方法进行分析总结,随访患者的并发症及术后血管再通情况。结果总计34例患者全部进行随访,男性29例(85.29%),女性5例(14.71%)；最大年龄81岁,最小年龄49岁,平均年龄(67.5±8.1)岁,术后随访时间3～12个月,平均(10.4+3.7)月。支架组早期并发症发生率为11.8%,旁路组为23.5%,差异无统计学意义(P0.05)；支架组手术前后ABI值分别为0.25±0.21和0.51±0.25,差异有统计学意义(P0.05)；旁路组手术前后ABI值分别为0.34±0.19和0.57±0.22,差异有统计学意义(P0.05)；支架组12个月通畅率为88.2%,旁路组为82.4%,两组通畅率差异有统计学意义P0.05)。结论腔内支架置入术具有创伤小,出血少,恢复快,并发症发生率低等优点,是治疗主髂动脉闭塞性疾病的理想术式。然而有文献认为,腔内支架置入的术后再通率和长期疗效远低于主-双股动脉旁路术。由于此次研究样本量少,随访时间短,两种术式的远期通畅率有待进一步临床研究。
[Abstract]:Objective to evaluate the indications, technical points, complications, patency rate and curative effect of endovascular stenting and major-double femoral artery bypass in the treatment of major iliac artery occlusive diseases. Methods from April 2011 to October 2013, 105 patients with major iliac artery occlusion were selected and included in this study, including 17 patients with intermittent claudication and 7 patients with lower extremity resting pain. 10 cases were complicated with ulcer or gangrene. The patients were divided into two groups according to the two types of operation. The preoperative data, indications and methods of operation were analyzed and summarized. The complications of the patients and the recanalization of the blood vessels were followed up. Results A total of 34 patients were followed up, 29 males (85.29%) and 5 females (14.71%), the maximum age was 81 years old, the minimum age was 49 years, the average age was (67.5 卤8.1) years, the follow-up time was 3 ~ 12 months (mean 10.43.7) months. The incidence of early complications in stent group was 11.8%, and that in bypass group was 23.5.The ABI of stent group before and after operation was 0.25 卤0.21 and 0.51 卤0.25, respectively (P0.05). The ABI of the bypass group was 0.34 卤0.19 and 0.57 卤0.22, respectively (P0.05), the patency rate of the stent group was 88.2g at 12 months, and the bypass group was 82.4g, the difference between the two groups was significant (P0.05). Conclusion Endovascular stent implantation has the advantages of less trauma, less bleeding, faster recovery and lower incidence of complications. It is an ideal method for the treatment of major iliac artery occlusive diseases. However, the rate of recanalization and long-term effect of endovascular stent implantation is much lower than that of main-double femoral artery bypass. Because of the small sample size and short follow-up time, the long term patency rate of the two operations needs further clinical 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】：R654.4

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