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慢性主髂动脉闭塞症手术与介入治疗中期疗效比较

Comparison of mid-term outcomes between surgical treatment and endovascular reconstruction for chronic aortoiliac occlusion

摘要:

目的 比较手术与介入方法治疗慢性主髂动脉闭塞症的中期血管通畅率、保肢率等,探讨介入手段治疗慢性主髂动脉闭塞症的适应证与可行性.方法 回顾性分析中国医科大学附属第一医院2005年1月至2010年12月68例成功接受手术或介入治疗的慢性主髂动脉闭塞症患者的资料,其中手术组33例,介入组35例.利用t检验和x2检验比较两组患者的术前危险因素、合并症、踝肱指数等指标,利用Kaplan-Meier法和Log-rank检验比较中期生存率、保肢率及通畅率.结果 手术组患者较介入组更年轻[(56±11)岁比(65±10)岁,t=-2.789,P=0.008],症状上更多表现为静息痛(23/33比15/35,x2=4.963,P=0.026),有相对较高的围手术期病死率(3/33比0/35,P=0.109).两组患者术后症状均得到改善,踝肱指数提高明显(手术组0.90±0.15比0.43 ±0.20,t=-7.849,P =0.000;介入组0.85±0.20比0.41 ±0.25,t=-5.379,P=0.000).术后并发症方面,手术组发生呼吸功能不全、肾功能不全及多器官功能衰竭的比例高于介入组(x2=6.98,P =0.010;x2 =9.62,P=0.000;P =0.023).手术组患者术后5年原发通畅率为91.4%,介入组为64.2%,Log-rank检验差异无统计学意义(x2 =3.717,P=0.054).两组的保肢率、二期通畅率同样差异无统计学意义.结论 介入手段治疗Leriche综合征的中期原发通畅率仍低于传统开放手术,对于能够耐受手术风险的患者,开放手术仍然是最佳选择.而对于高危患者,如无法耐受手术可考虑介入治疗,必要时多次接受介入干预,同样可以达到较好的中期治疗效果.

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abstracts:

Objective To compare mid-term results of surgical treatment with aortoiliac stenting (AIS) in patients with chronic aortoiliac occlusion.Methods A retrospective review of 68 patients treated between January 2005 and December 2010 was performed.Thirty-three patients underwent surgical revascularization (surgical group) and 35 patients underwent AIS (AIS group).Preoperative clinical factors and outcome data including complications,ankle-brachial index and mortality were collected.Kaplan-Meier estimates for survival,limb salvage and patency were analyzed.Results Preoperative risk factors were similar between the two groups.Surgical group were younger than AIS group ((56 ± 11) years vs.(65 ± 10) years,t =-2.789,P =0.008) with more patients manifesting rest pain (23/33 vs.15/35,x2 =4.963,P=0.026) and relative higher perioperative mortality (3/33 vs.0/35,P =0.109).Mean anklebrachial index increased significantly in both groups after operation (Surgical group 0.90 ± 0.15 vs.0.43 ± 0.20,t =-7.849,P =0.000;AIS group 0.85 ±0.20 vs.0.41 ± 0.25,t =-5.379,P =0.000).Postoperative complications occurred,with statistically higher rates of respiratory failure,transient renal dysfunction and multiple organ dysfunction syndrome in surgical group (x2 =6.98,P =0.010;x2 =9.62,P =0.000;P =0.023).The 5-year primary patency in surgical group was 90.2%,compared with 64.2% in AIS group (x2 =3.717,P =0.054).No difference was observed in survival rate,limb salvage and secondary patency between the two groups.Conclusions Five-year primary patency of endovascular reconstruction for chronic aortoiliac occlusion is lower than that for traditional open surgery.Open surgery is still the first choice for the patients who can endure the surgery.Endovascular treatment is an option for patients with high risk.However,additional interventional treatment is needed in some cases.

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