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腘动脉闭塞的手术治疗经验

Surgical treatment for popliteal artery occlusive disease

摘要:

目的 探讨单纯腘动脉闭塞的外科治疗的策略及效果.方法 回顾性分析2007年6月至2008年6月25例单纯腘动脉闭塞患者手术治疗的临床资料.男性18例,女性7例;年龄17~83岁,平均(53±21)岁.急性缺血11例11条肢体(42.3%),慢性缺血14例15条肢体(57.7%).手术方式包括腘动脉取栓4条肢体,补片成形19条肢体,自体静脉旁路或间位移植2条肢体.人工血管间位移植1条肢体.其中6条肢体在血管重建手术同期行腓肠肌内侧头离断松解术.结果 本组患者手术均获成功,24例患者25条肢体症状改善,间歇性跛行距离延长;术后踝肱指数为0.75±0.29,高于术前的0.35±0.20(P<0.01).随访4~16个月,平均10.2个月,一期通畅率为92.3%;术后截肢3例,保肢率为88.5%.结论 腘动脉闭塞成因复杂,采取个体化手术治疗策略方能获得满意疗效.

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Objective To investigate surgical procedures for popliteal artery occlusive disease. Methods The clinical data of 25 patients with popliteal artery occlusive disease from June 2007 to June 2008 was analyzed retrospectively. There were 18 male and 7 female with an average age of (53 ± 21 ) years. Eleven patients ( 11 limbs, 42. 3% ) were acute limb ischemia and 14 patients ( 15 limbs, 57. 7% ) were chronic limb ischemia All patients were treated with surgical revascularization. Four limbs underwent throbectomy. Nineteen limbs underwent endarterectomy with patch below knee. Three limbs underwent femoral-popliteal bypass with reversed saphenous vein or graft Six of all the limbs underwent resection of the aberrant muscle when revascularization. Results Ischemic symptoms and claudication distance were improved in 24 patients ( 25 limbs ) . Postoperative ankle-branch index ( ABI ) was 0.75 ± 0. 29, significantly higher than preoperative ABI 0. 35 ± 0. 20 ( P < 0. 01). Average follow up time was 10. 2 months. I stage patency rate was 92. 3%. Three patients were amputated postoperatively. The rate of limb salvage was 88. 5% in this study. Conclusions The cause of popliteal artery occlusive disease are diverse. Treatment for popliteal artery occlusive disease should depend on its etiology to make the outcomes be satisfied.

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