大隐静脉原位动脉化修复脉管炎及动脉硬化闭塞症临床应用研究.docVIP

大隐静脉原位动脉化修复脉管炎及动脉硬化闭塞症临床应用研究 　　[摘要] 目的 探索原位一期静脉动脉化方式治疗脉管炎及动脉硬化闭塞症的临床应用可行性。方法 方便收集2011年6月―2014年12月该院采用静脉瓣膜切除或破坏、原位一期静脉动脉化治疗的56例（61条患肢）脉管炎患者及60例（81条患肢）动脉硬化闭塞症，观察术后患者行走和患肢缺血状态、疼痛、皮肤等情况。结果142条患肢术后患肢缺血症状明显改善，26例剧烈静息痛明显缓解。所有患者静脉搏动良好，肢端循环显著改善，皮肤温度较前升高。67例手术后患肢末梢即由青紫色变为暗红色，皮肤温度恢复正常。术后随访6～24个月，肢缺血症状完全消失，坏疽足趾脱落，残端完全愈合，踝上大隐静脉触及搏动。 结论 静脉瓣膜切除或破坏、原位一期静脉动脉化方式治疗脉管炎及动脉硬化闭塞症效果良好，值得推广。 　　[关键词] 静脉动脉化；脉管炎；动脉硬化闭塞症；手术 　　[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2016）05（b）-0017-03 　　[Abstract] Objective To explore the clinical application feasibility of primary in situ vein graft arterialization method in treatment of vasculitis and arteriosclerosis obliterans. Methods 56 cases of patients with vasculitis（61 affected limbs） and 60 cases of patients with arteriosclerosis obliterans （81 affected limbs） treated with venous valve removal or destruction and primary in situ vein graft arterialization therapy in the department of orthopaedics from June 2011 to December 2014 were collected， and the walking， ischemic state of the affected limbs， pains， skin and other conditions of the postoperative patients were observed. Results The ischemic state of the affected limbs after operation of 142 cases was obviously improved， the severe rest pain of 26 cases was obviously relieved， the venous pulse of all patients was good， acra circulation was obviously improved， skin temperature was elevated compared with that before， the color of the affected limb endings after operation of 67 cases was from violaceous color to dark red， and the skin temperature returned to normal， after 6-month to 24-month of follow-up， the ischemia symptoms of the affected limbs totally disappeared， toe gangrenosum desquamated， stump was totally cured and ankle great saphenous vein touched pulse. Conclusion The effect of venous valve removal or destruction and primary in situ vein graft arterialization method in treatment of vasculitis and arteriosclerosis obliterans is good， which is worth promotion. 　　[Key words] Vein graft ar