發(fā)布時(shí)間：2018-10-05 19:01

【摘要】：目的探討腔內(nèi)支架置入術(shù)與主-雙股動(dòng)脈旁路術(shù)在治療主髂動(dòng)脈閉塞性疾病的適應(yīng)證、技術(shù)要點(diǎn)、并發(fā)癥、通暢率及評(píng)估其療效。方法搜集2011年4月至2013年10月間,于我院血管外科行手術(shù)干預(yù)的主髂動(dòng)脈閉塞疾病共105例,隨機(jī)選取并納入34例(41條患肢),其中間歇性跛行17例,下肢靜息痛7例,合并潰瘍或壞疽10例。按兩種術(shù)式將其平均分為兩組,對(duì)患者的術(shù)前資料、手術(shù)適應(yīng)證、手術(shù)方法進(jìn)行分析總結(jié),隨訪患者的并發(fā)癥及術(shù)后血管再通情況。結(jié)果總計(jì)34例患者全部進(jìn)行隨訪,男性29例(85.29%),女性5例(14.71%)；最大年齡81歲,最小年齡49歲,平均年齡(67.5±8.1)歲,術(shù)后隨訪時(shí)間3～12個(gè)月,平均(10.4+3.7)月。支架組早期并發(fā)癥發(fā)生率為11.8%,旁路組為23.5%,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；支架組手術(shù)前后ABI值分別為0.25±0.21和0.51±0.25,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；旁路組手術(shù)前后ABI值分別為0.34±0.19和0.57±0.22,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；支架組12個(gè)月通暢率為88.2%,旁路組為82.4%,兩組通暢率差異有統(tǒng)計(jì)學(xué)意義P0.05)。結(jié)論腔內(nèi)支架置入術(shù)具有創(chuàng)傷小,出血少,恢復(fù)快,并發(fā)癥發(fā)生率低等優(yōu)點(diǎn),是治療主髂動(dòng)脈閉塞性疾病的理想術(shù)式。然而有文獻(xiàn)認(rèn)為,腔內(nèi)支架置入的術(shù)后再通率和長(zhǎng)期療效遠(yuǎn)低于主-雙股動(dòng)脈旁路術(shù)。由于此次研究樣本量少,隨訪時(shí)間短,兩種術(shù)式的遠(yuǎn)期通暢率有待進(jìn)一步臨床研究。
[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 鹵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 鹵0.21 and 0.51 鹵0.25, respectively (P0.05). The ABI of the bypass group was 0.34 鹵0.19 and 0.57 鹵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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.4

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