锁骨下动脉闭塞69例治疗分析.docVIP

锁骨下动脉闭塞69例治疗分析 ?来源：血管外科? [摘要] 目的 探讨腔内及手术治疗锁骨下动脉闭塞的方法和疗效。方法 2002年1月到2007年7月腔内及手术治疗锁骨下动脉闭塞症69例。腔内治疗44例，手术治疗25例，其中单纯球囊扩张3例，同时行支架植入者41例，植入支架43枚。结果 所有患者均顺利完成手术或腔内治疗，腔内治疗组患/健侧血压比由术前0.66±0.14提高至术后0.96±0.13（t=9.532,P0.001），手术组患/健侧血压比由术前0.63±0.16提高至术后0.95±0.18（t=8.236,P0.001），61例患者随访时间2~49个月，平均16.7个月，介入治疗组有1例术后1年出现支架结合部位狭窄，手术组随访人工血管均保持通畅，无人工血管相关并发症。结论 腔内治疗和手术治疗均是治疗锁骨下动脉闭塞的有效方法，腔内治疗因具有微创的特点，应作为治疗的首选方法。 [关键词] 锁骨下动脉；动脉闭塞性疾病；介入治疗；外科手术 Therapy for subclavian artery occlusion:a clinical study of 69 cases [Abstract] Objective to investigate the method and effect of endovascular therapy and surgery for subclavian artery occlusion disease. Methods 69 patients received endovascular therapy or surgery from January 2002 to July 2007. 44 patients received endovascular therapy and 25 patients receiced surgery, including balloon dilatation in 3 cases and stent placement in 41 cases, 43 stents were implanted. Results the procedures were completed successfully in all patients.In endovascular therapy group, the ratio of healthy/dieased side of mean blood pressure was improved from 0.66±0.14 to 0.96±0.13（t=9.532,P0.001）;in surgery group,the ratio improved from 0.63±0.16 to 0.95±0.18（t=8.236,P0.001）.61 patients were followed for 2~49 months(mean,16.7 months), in endovascular group, restenosis occurred in 1 patient 1 year after the therapy, in surgery group, all prothesis remained patent and there was no complication related to prothesis. Conclusions Both endovascular therapy and surgery were the effective methods of subclavian artery occlusion, endovascular therapy was the preferred method for mini-trauma. [key words] Subclavian artery; Arterial occlusive diseases; Endovascular therapy; Surgery ??? 锁骨下动脉闭塞症是血管外科常见疾病，可因锁骨下动脉窃血（SSS）引起椎基底动脉供血不足及同侧上肢缺血症状。我院自2002年1月到2007年7月共收治锁骨下动脉狭窄或闭塞患者69例，采用介入或外科手术进行治疗，均取得了较好的效果，现总结如下。 资料与方法 一、一般资料 ??? 本组患者69例，男40例，女29例。年龄25~82岁，平均58.5岁。所有患者均有一侧或双侧脉搏减弱或消失，部分病人有椎基底动脉供血不足的表现，如头晕、头痛、眼花、黑蒙等，其中部分病人在上肢活动后上述症状加重，另外部分病人有患侧上肢缺血的表现如患肢疼痛、发凉、乏力等。病因有5例为大动脉炎，其余均为动脉硬化。术前均行多普勒