忽略股浅动脉重建在治疗慢性下肢动脉硬化闭塞症中的临床意义

摘要

目的评价忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的临床意义。方法回顾分析2003年1月～2013年12月155例（220条患肢）股浅动脉重度狭窄、闭塞的下肢动脉硬化闭塞症的临床资料。根据对股浅动脉的处理方法，将患者分为股浅动脉重建组（107条患肢）和非重建组（113条患肢），比较2组患者的临床疗效。结果重建组近期（出院时）总有效率明显优于非重建组[70.1％（75／107）vs．46．0％（52／113），Z＝－2．356，P＝0．018]，随访期内2组总有效率无统计学差异[53．3％（57／107） vs．57．5％（65／113），Z＝－0．633，P＝0．527]。2组保肢率无统计学差异[94．4％（101／107） vs．96．5％（109／113），χ2＝0．170，P＝0．680]。重建组再次腔内治疗率更高[30．8％（33／107） vs．8．8％（10／113），χ2＝16．903， P＝0．000]，费用更高[（34658．7±8322．7）元vs．（17036．6±1603．0）元，t＝22．082，P＝0．000]。2组围手术期病死率和并发症发生率无统计学差异[0 vs．0．9％（1／113），Fisher 精确检验，P＝1．000；1．9％（2／107） vs．1．8％（2／113），Fisher 精确检验，P＝1．000]。结论忽略股浅动脉重建治疗下肢动脉硬化闭塞症安全、有效、经济，应成为部分患者的首选治疗方法。%Objective To study the clinical significance of neglecting superficial femoral artery reconstruction for chronic lower extremity arteriosclerosis obliterans . Methods One hundred and fifty-five patients (220 limbs) treated for sever stenosis or occlusion of superficial femoral artery resulted by arteriosclerosis obliterans in ten years were reviewed .Among them there were 107 limbs treated by endovascular reconstruction of superficial femoral artery ( reconstruction group ) and the other 113 limbs were only treated with the accompanied iliac and/or profunda femoral artery lesion without superficial femoral artery treatment ( non-reconstruction group) . Results Compared with the non-reconstruction group , the reconstruction group had a better short-term total effective rate [70.1%(75/107) vs.46.0%(52/113), Z=-2.356, P=0.018].There were no significant differences between the two groups on long-term total effective rate [53.3%(57/107) vs.57.5%(65/113), Z=-0.633, P=0.527] and limb salvage rate [94.4%(101/107) vs.96.5%(109/113), χ2 =0.170, P=0.680].The reconstruction group had a higher re-operation rate [30.8%(33/107) vs.8.8%(10/113),χ2 =16.903, P=0.000] and a higher cost [(34 658.7 ±8322.7) yuan vs.(17 036.6 ±1603.0) yuan, t=22.082, P=0.000] as compared with the non-reconstruction group.There was no significant difference between the two groups on the morbidity of complications and death [0 vs.0.9%(1/113), Fisher’s exact test, P=1.000;1.9%(2/107) vs.1.8%(2/113), Fisher’s exact test,P=1.000]. Conclusion Dealing with accompanied iliac and profunda artery lesion and neglecting superficial femoral artery reconstruction is a safe , effective and inexpensive therapy for lower extremity arteriosclerosis obliterans , and should be the preferred alternative for some patients .