摘要目的 总结腘动脉陷迫综合征(PAES)的诊断和外科治疗效果.方法 回顾性分析2006年3月至2009年8月收治的11例(14条患肢)PAES患者的诊断和治疗情况.其中男性9例,女性2例;年龄15～56岁,中位年龄22岁.双侧PAES 3例.首诊症状8例为间歇性跛行,3例为静息痛,出现症状至首次就诊时间为3周～10年.14条肢体通过多层螺旋CT明确诊断为PAES.Delaney's Ⅱ型或Ⅲ型11条肢体,Ⅴ型1条肢体,Ⅰ型2条肢体.手术方法包括单纯行腘动脉松解术2条肢体,行腘动脉松解、血栓内膜剥脱、补片成形术8条肢体,行置管溶栓、腘动脉松解术2条肢体,直接行股-腘(膝下)动脉自体大隐静脉原位转流术2条肢体.结果 术后所有患者临床症状缓解.随访1～36个月,中位随访13个月,1例患者术后6个月复发,再次溶栓成功后行腘动脉松解术.一期通畅率92.9%(13/14),累计通畅率100%,救肢率100%.12条腘动脉闭塞肢体术后中立位踝肱指数较术前升高(1.11±0.10比0.62±0.14,P<0.01).结论 多层螺旋CT对PAES的诊断和分型具有重要意义.PAES诊断明确后应尽快手术治疗.根据腘动脉闭塞情况选择适当的手术方法可获得满意效果.

abstractsObjective To summarize advancement of diagnosis and surgical intervention of popliteal artery entrapment syndrome (PAES). Methods From March 2006 to August 2009, 11 patients (14 limbs)underwent surgical procedures, including 9 males (81.8%) , with a median age of 22 years old ( arranged from 15 to 56 years old). Three cases (27. 2% ) had both limbs involved. The chief complaint contained intermittent claudication in 8 cases and rest pain in 3 cases. The time from onset to admission arranged from 3 weeks to 10 years. 14 limbs were diagnosed as PAES through multidetector spiral computed tomography.Eleven cases were diagnosed as Delaney's type Ⅱ or Ⅲ, 1 case as type Ⅴ and 2 cases as type Ⅰ . Two limbs underwent popliteal artery release only, 8 limbs underwent politeal artery release,thromboendarterectomy and angioplasty with a venous or prosthetic patch, 2 patients complaining acute limb ischemia underwent catheter-based thrombolysis and popliteal artery release subsequently, 2 patients with a occlusive segment longer than 5 cm in popliteal artery underwent below-knee femoral-popliteal artery bypass with in-situ greater saphenous vein graft. All the patients undertook anticoagulation treatment with coumadin after the operation. Results All the patients had their clinical symptoms released after the operation. One patient ( 1 limb) was recurrent 20 months after the operation and underwent embolectomy successfully. At a median follow up of 13 months (range 1 to 36 months), the primary patency rate was 92. 9% ( 13/14), the total patency rate was 100% (14/14) and limb salvage rate was 100%. The ankle brachial index at neutral position improved significantly after the surgery in the 12 occluded limbs ( 1.11 ± 0. 10 vs. 0. 62 ± 0. 14,P <0.01 ). Conclusions Multidectector spiral computed tomography is much helpful in diagnose and typing of PAES. Surgery should be performed as soon as the PAES is diagnosed. Appropriate surgical intervention can achieve satisfying effect according to different character of popliteal artery occlusions.