摘要
目的探讨采用"杂交术式"(球囊扩张、支架植入联合内膜剥脱及取栓)治疗糖尿病性下肢动脉硬化闭塞症的远期疗效。方法回顾性分析2005年1月至2009年11月,采用双侧股动脉穿刺球囊扩张+支架置入、内膜剥脱+介入、导管取栓+介入方法治疗的糖尿病性下肢动脉硬化闭塞症198例的临床资料,病变259侧肢体,双侧病变61例,单侧病变137例,次级血管病变(股动脉至腘动脉段病变)213条,初级血管病变(胫前及胫后动脉病变)221条;随访6～36个月,统计分析患者腘动脉以下血管(初级血管)及股浅动脉(次级血管)的通畅率及其相关影响因素。结果198例患者中初次治疗成功率分别为初级血管90%,次级血管92%。随访6～36个月,DLASO初级血管的首次通畅率由77%降至47%,次级血管的通畅率由88%降至62%。DLASO初级血管的累积二次通畅率为67%～89%,次级血管的累积二次通畅率为73%～93%。支架植入组的狭窄率显著低于单纯球囊括张组(P<0.05)。结论"杂交术式"治疗糖尿病性下肢动脉硬化闭塞症适应证广泛,疗法肯定。控制相关影响因素,可有效提高疗效。
Objective To evaluate the effect and influencing factors after undergoing complex operation through balloon angioplasty, endovascular stent implantation （stenting）combined with endarterectomy and thrombectomy in lower extremity arterial occlusive disease. Methods From January of 2005 to November of 2009, 318 patient＇ s clinical data were retrospectively studied after the patients undergoing the double femoral artery centesis balloon angioplasty and endovascular stent implantation （stenting） or endarterectomy and endovascular repair or thrombectomy and endovascular repair to cure lower extremity arterial occlusive disease,including 198 with DLASO （61 with bilateral lesions）259 side extremity, 120 with LEAOD （41 with bilateral lesions）161 side extremity. Follow-up was 6 to 36 months, the correlation factors and patency rate of popliteal artery following vascular（primary vascular）and superficial femoral artery（secondary vascular）were analyzed. Result＇s A total of 318 patient＇s in the initial success rate was DLASO 90% with primary vascular, 92% with secondary vascular; LEAOD 91% with primary vascular, 94% with secondary vascular respectively. Mean follow-up 6 to 36 months, the primary patency in patients with DLASO was significantly lower than patiences with LEAOD. The accumulated （total）secondary patency for primary vascular was 67%～89%, for secondary vascular was 73%～93% respectively. The restenosis rates in the two groups with stenting was significantly lower then those with balloon angioplasty（P 〈0.05）. Multivariate logistic regression analysis on univariate analysis showed that reduced patency rates in DLASO were related to tobacco use history, hypertension and many other factors. No patients with perioperative death and serious complications. Conclusion There are satisfactory results about the use of complex operation for lower extremity arterial occlusive disease. The clinical effects would be improved, if the influencing factors are controlled effectively.
出处
《医学研究与教育》
CAS
2010年第2期17-19,共3页
Medical Research and Education
关键词
糖尿病
动脉硬化闭塞症
腔内治疗
支架
diabetes
arterial occlusive disease
endovascular repai（rEVR）
stenting
