下肢动脉搭桥术后移植物闭塞外科治疗体会.docVIP

下肢动脉搭桥术后移植物闭塞外科治疗体会 　　　　李清乐，张小明，张学民，沈晨阳，李 伟　　　　　　　　　　　　　　　【摘要】 目的 探讨下肢动脉搭桥术后再缺血的治疗策略。方法 选择2002年7月～2006年2月我院收治下肢动脉搭桥术后移植物闭塞患者21例，男17例，女4例，平均68.2岁；21例患者共行手术35例次：再次下肢动脉搭桥术16例次（45.7%），单纯人工血管取栓手术10例次（28.6%），人工血管取栓同时行股或腘动脉内膜剥脱术6例次（17.1%），3例患者行截肢术（8.6%）。结果 35例次手术探查发现移植物闭塞原因以远侧流出道病变（62.9%）和远侧吻合口内膜增生（25.7%）为主。其中13例次术后再次闭塞行手术治疗，但人工血管搭桥术平均再发闭塞时间明显长于其他术式。2例患者围手术期死亡。17例患者末次行血运重建手术，术后随访6～44个月，平均17个月，未见缺血症状复发。结论 下肢动脉搭桥术后移植物闭塞原因以远侧流出道病变为主，再次搭桥手术可作为首选术式，术后缺血反复发作导致截肢。 【关键词】 下肢；移植物闭塞；血管；截肢术 【Abstract】 Objective To report our experience of surgical treatment for 35 graft failure cases in 21 patients with lower extremity bypass and discuss the appropriate treatment strategy.Methods Twenty-one patients with graft failure after primary bypass grafting were treated from July 2002 to February 2006，including 17 males and 4 females with the mean age of 68.2 years.A total of 35 operations were applied： renewed bypass grafting for 16 cases（45.7%），thrombectomy of failed prosthetic grafts for 10 cases（28.6%），thrombectomy of failed prosthetic grafts and femoral or popliteal artery for 6 cases（17.1%），and below-knee amputation for 3 cases（8.6%）.Results Intraoperative findings in 35 cases suggested that distal atherosclerotic lesions（62.9%）and distal anastomosis intimal hyperplasia（25.7%）account for most ischemic recurrences.Repeated graft failure occurred in 13 cases and renewed bypass grafting operations had a longer average recurrent interval than others.Two patients died during the perioperative period.Revascularization were accomplished in 17 patients followed up for 6 to 44 months with an average of 17months，and no ischemic recurrence was noticed.Conclusion Graft failures of lower extremities bypass is mainly caused by distal atherosclerotic progression and renewed bypass operation maybe a more promising choice.Repeated ischemic recurrence may eventually results in amputation. 【Key words】 lower extremity；graft occlusion；vascular；amputation 下肢动脉旁路搭桥手术是治疗下肢动脉闭塞的经典手术方式，提高移植物的通畅率一直以来是血管外科