摘要
作者对１９８９年～１９９４年运用自制瓣膜切除器开展原位大隐静脉动脉旁路术治疗下肢动脉硬化闭塞症２８例共３０条肢体的方法、疗效和治疗体会进行了总结。患者术前踝肱指数（ＡＢＩ）为０～０．５７（平均０．４１），均经动脉造影证实。术后移植物均可扪及搏动，有１８条肢体恢复足背或胫后动脉搏动。１７例同时行输入或输出道动脉重建术。溃疡清创术６例。３例于术后３天内出现移植物搏动消失，行第二次重建术。治疗结果，ＡＢＩ平均值由术前的０．４１上升至０．８４，严重缺血肢体挽救率为１００％。术后随访，经寿命表统计分析，１～５年的血管累积通畅率分别为９２％、８８％、８６％、７８％和７１％。作者认为，原位大隐静脉动脉旁路术是治疗下肢动脉硬化闭塞症的理想方法之一，同时行输入或输出道动脉重建术，对保证移植血管的通畅有着重要的意义。
patientswith30ischemiclowerlimbsweretreatedbyinsitusaphenousveinfemoro-distalarterialbypassusingself-madevalvulotomeatZhongshanHosptalfrom1989to1994.Alpatientshadclaudicationinthelowerextremitiesandwerediagnosedangiographicaly.ThepreoperativeABIwasfrom0to0.57(mean0.41).Altheveingraftswerepatentpostoperationandthedorsalispedisorposteriortibialarterieswerepalpablein18legsimmediatelypostoperation.Seventeenpatientshadcon-comitantarterialreconstruction.Graftocclusionwithin3daysafteroriginaloperationsoccurredinthreecasesandsecondarysurgicalcorrectionsweresuccessful.PostoperativemeanABIincreasedfrom0.41to0.84.Thelimbsalvageratewas100%andthecumulativepatencyrate,bythelifetableanalysisin1,2,3,4and5years,were92%,88%,86%,78%and71%respectively.Theresultssuggestthattheinsitusaphenousveinarterialbypassisthesuperiormethodfordistalarterialreconstructionandconcomitantprocedurestoensuresufficientinflowaswelasoutflowareessentialtothepatencyofthegraft.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1996年第9期549-552,共4页
Chinese Journal of Surgery
