摘要
目的分析股-腘人工血管移植术后移植血管再闭塞的病因以及相关治疗措施。方法选取2015年3月至2017年3月诊治的行股-膝上腘血管旁路移植手术(单/双侧)的全身动脉硬化闭塞症(ASO)患者82例,患肢共88条。分析影响患者术后移植血管再闭塞的影响危险因素及有效的治疗措施。结果术后即时、术后6、12、24个月时患者移植血管累积通畅率分别为90. 91%、87. 12%、84. 31%和82. 56%。COX回归分析显示影响患肢血管再闭塞的危险因素有术前并存糖尿病、高脂血症、既往吸烟史和术前膝下仅有1条流出道通畅(P均<0. 05)。根据Kaplan-Meier法计算的术后6、12、24个月累积通畅率结果,术后6、12个月统计,闭塞组患者吸烟史分别为72. 73%、76. 92%,明显高于通畅组的31. 88%、33. 33%(P <0. 05,P <0. 01);术后24个月统计,闭塞组患者糖尿病为64. 29%、吸烟史为71. 43%、术前膝下仅有1条流出道通畅者为57. 14%,明显高于通畅组(23. 40%,31. 91%,21. 28%,P <0. 05,P <0. 01)。结论股-腘动脉人工血管移植术后血管再闭塞的危险因素有术前并存高脂血症、糖尿病、术前膝下仅1条流出道通畅及有吸烟史,而后三者是股-腘动脉旁路术后远期再闭塞的危险因素。对于以上危险因素进行对症治疗,可提高股-腘人工血管移植术后通畅率。
Objective To analyze the reason of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the relative treatment measures. Methods A total of 82 patients( 88 affected limbs) with systemic arteriosclerosis obliterans( ASO) who underwent bypass grafting( single/bilateral) of femoral and popliteal above-knee vessels from March 2015 to March 2017 were selected. The risk factors influencing reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting and the effective treatment measures were analyzed. Result The cumulative patency rates immediately after operation and at 6-,12-and 24-month after operation were 90. 91%,87. 12%,84. 31% and 82. 56%,respectively. COX regression analysis showed that smoking history,preoperative coexisted with diabetes mellitus,hyperlipidemia and preoperative patency of only one outflow tract below the knee were the risk factors for revascularization( all P < 0. 05). According the results of cumulative patency rate calculated by Kaplan-Meier method,at6-,12-month after operation the incidences of preoperative smoking history in the occlusion group( 72. 73%,76. 92%)were significantly higher than those in the patency group( 31. 88%,33. 33%)( P < 0. 05,P < 0. 01);while at 24-month after operation,the incidences of preoperative concurrent diabetes,smoking history and preoperative patency of only one outflow tract below the knee in the occlusion group( 64. 29%,71. 43%,57. 14%) were significantly higher than those in the patency group( 23. 40%,31. 91%,21. 28%)( P < 0. 05 or P < 0. 01). Conclusions The risk factors of reocclusion of vascular prosthesis after femoral-popliteal artificial blood vessel grafting are diabetes,hyperlipidemia,only one outflow pathway patency below the knee and smoking history before operation,while the late three are the risk factors of long-term reocclusion after femoral-popliteal artery bypass. The symptomatic treatment should be taken for directing against the above risk factors to improve the patency rate of femoral-popliteal artificial blood vessel.
作者
李阳春
栗力
齐新
曹月娟
LI Yang-chun;LI Li;QI Xin;CAO Yue-juan(Graduate School of Tianjia University of Traditional Chinese Medicine,Tianjin 300193,China)
出处
《中国临床研究》
CAS
2019年第1期31-34,38,共5页
Chinese Journal of Clinical Research
基金
天津市人民医院重点科技项目(2016YJZD007)~~
关键词
股-腘人工血管移植术
再闭塞
危险因素
通畅率
吸烟史
糖尿病
高脂血症
Femoral-popliteal artificial blood vessel grafting
Reocclusion
Risk factors
Patency rate
Smoking history
Diabetes
Hyperlipidemia
