关于单纯球囊扩张与球囊扩张并支架植入治疗股胭动脉硬化闭塞症的临床研究

发布时间：2018-04-16 10:04

本文选题：下肢动脉硬化闭塞症 + 股乆动脉　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:由于目前国内外对于股乆动脉动脉硬化闭塞症是否一期置入支架还存在有较大争议[1]。因此,本研究是回顾性分析我科收治的患有股乆动脉硬化闭塞疾病的患者进行腔内血管成形术或是支架植入术治疗后的效果。并比较是否符合国内外现有的临床研究,同时深入对股乆动脉B、C及D型病变进行两种治疗方法比较,进一步明确分型对不同腔内治疗方法的选择。方法:回顾分析广西医科大学一附院血管外科2010.09-2016.09收治的患有股乆动脉硬化闭塞疾病的患者进行经皮腔内血管成形术或是支架置入术的患者共72例(77条患肢),男62例,女10例,年龄在42-101岁,平均年龄69.88±11.23岁。根据治疗方式不同将其分为单纯球囊扩张组(共40例,42条肢体),球囊扩张并支架植入组(共32例,35条肢体)。对合并有髂动脉、膝下动脉病变患者一并进行相应血管开通治疗。并对TASCIIB/C、D型再次进行分组比较,随访并记录患者术前术后ABI、术后平均22.4±15.7个月(6-36个月)的临床症状、累积通畅率、保肢率、生存率等,进行统计学分析,比较二者疗效如何,并根据分型所实行不同治疗方法的比较,进一步明确不同分型所应选择的恰当腔内治疗方式。结果:72例(共77条患肢)当中,成功开通病变患肢74条,技术成功率达96.1%(74/77)。围手术期死亡率达4.2%(3/72)。主要并发症发生率6.9%(5/72)。术后短期内两组患者肢体症状、溃疡愈合情况及踝肱指数均有明显改善,组内对比差异有统计学意义(P0.05),组间对比差异无统计学意义(P0.05)。术后随访的6月、12月、24月、36月PTA组和PTAS组的初期通畅率分别为:71.1%、81.3%,64.5%、63.0%,54.5%、57.9%,53.8%、61.5%。保肢率分别为:92.1%、96.9%,96.7%、89.3%,94.1%、93.3%,92.9%、100%。生存率分别为:90%、87.5%,84.6%、81.3%,81.3%、77.9%,81.3%、71.4%。随访过程中,两组血管的通畅率、保肢率及生存率经统计学分析,均无统计学意义(P0.05),但对B、C型进行随访统计显示,随访期内B型两组通畅率分别为:77.1%、65.2%,保肢率为:93.8%、88.9%。C型两组通畅率分别为:46.3%、66.7%,保肢率为:86.7%、94.9%。B、C型的保肢率无明显差异(P0.05)。B型通畅率二者无明显统计学意义,C型通畅率二者有统计学意义(P0.05)。结论:研究结果显示,单纯球囊扩张和球囊扩张并支架置入术治疗股乆动脉硬化闭塞在近中期疗效基本相近,差异无统计学意义,但进一步对股乆动脉病变分型更进一步进行统计分析,A、B型病变可以单纯球囊扩张为主,C、D型病变可偏向选择球扩并支架置入治疗。但由于样本量较少,远期疗效及分型治疗选择的临床数据支持,还需增大样本量及延长随访时间进一步研究。
[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 卤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 卤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.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.5

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