【作者】 陈昱；

【导师】 郭平凡；

【作者基本信息】 福建医科大学 ， 外科学， 2011， 硕士

【摘要】 目的:评价腔内血管成形术治疗膝下动脉闭塞性疾病的疗效。材料与方法:本研究回顾性分析了2009年2月至2010年3月福建医科大学附属第一医院血管外科收治的膝下动脉缺血患者共71例(101条下肢),按接受的治疗方法将其分为PTA治疗组(I组)和药物保守治疗组(II组)。将两组临床资料分别按照年龄、性别、症状、跛行距离、治疗前合并症、治疗前后踝/肱指数(ABI)、治疗后ABI增加值、治疗后临床疗效等进行比较。对结果进行统计分析,以P<0.05为差异具有显著性界限。结果:本组71例患者(101肢),其中I组45例(52肢),II组26例(49肢)。两组患者年龄39 - 86岁(平均70.39±1.09岁),分布构成无明显差异(P>0.05)。全组病例中,男性49例,女性22例,两组性别构成无明显差异(P>0.05)。I组中临床治疗效果:显效者为55.77%,好转者为34.62%,无变化者为9.62%,恶化者为0;II组:显效者为0,好转者为20.41%,无变化者为79.59%,恶化者为0,两组间差异有统计学意义(Z=-7.54,P=0.000),I组较II组治疗效果好。I组术前ABI平均值为0.34±0.04,术后1周ABI平均值为0.86±0.03,与术前ABI值相比差异有统计学意义(P<0.05);II组治疗前ABI平均值为0.46±0.05,治疗后1周ABI平均值为0.50±0.04,与治疗前ABI值相比差异有统计学意义(P<0.05)。I组患者手术前、后ABI增加值平均为0.52±0.04,II组治疗前、后ABI增加值平均为0.04±0.01,两组相比差异有统计学意义(t=10.654,P=0.000)。6月后ABI值I组0.80±0.03,II组0.48±0.04,两组相比差异有统计学意义(t=6.468,P=0.000)。I组中,围手术期死亡率为0,发生术后并发症的患者占7.69%,救肢率为100%。结论:1. PTA作为膝下动脉缺血的治疗方法是可行、安全、有效的。2.膝下动脉PTA临床复发很少,可重复使用,推荐PTA应作为首选的治疗方法。3. PTA作为低损伤性治疗,其应用于膝下小动脉病变的治疗有效,但长期通畅性有待进一步观察更多还原

【Abstract】 Objective:To evaluate the clinical results of infragenicular percutaneous transluminal angioplasty (PTA) in the treatment of arteriosclerosis obliterans.Material and Method:This study retrospectively analyzed 71 patients (101 limbs) with infrapopliteal artery ischemia treated at vascular surgery department of the First Affiliated Hospital of Fujian Medical University from Feb 2009 to Mar 2010. The patients are divided into two groups according to their therapy: Group II with PTA treatment; Group II with only drug treatment. Two groups were compared according to their clinical features, including age, gender, course of disease, symptoms, limp distance, risk factor, ABI, ABI increment and clinical results after treatment, etc. Statistical analysis was performed with a significance difference level defined at P<0.05.Results:45 of 71 patients (52 limbs) were selected under Group I, while the rest 26 patients (49 limbs) were under Group II. The patients ranged from 39 to 86 years old (average 70.39±1.09), with 49 male and 22 female cases. No significance difference in age and gender between two groups was observed (P>0.05). The clinical results of Group I shows: 55.77% as“significantly improved”, 34.62% as“improvement”, 9.62% as“no change”; while Group II shows: 0% as“significantly improved”, 20.41% as“improvement”, 79.59% as“no change”; no worse condition was observed in both groups. There was significant difference between two groups, while Group I exhibited better clinical results than Group II. Group I and II had an average of pre-therapy ABI of 0.34±0.04, and 0.46±0.05 respectively. One week later, ABI of Group I and II had increased to 0.86±0.03 and 0.50±0.04, respectively, both showing significant difference compared to pre-therapy (P<0.05). For Group I patients, the average ABI had increased 0.52±0.04, which is much higher compared to Group II of 0.04±0.01. After 6 months, the average ABI were 0.80±0.03 and 0.48±0.04 for Group I and II respectively, still showing significant difference. For group I, no patient died in the therapy period. The patients exhibited post-operative complications were 7.69% and the limb salvage rate was 100%.Conclusion:1. PTA is feasible, safe and effective in treating critical infragenicular limb ischemia.2. Clinical recurrence of infrapopliteal PTA was infrequent and the procedure could successfully be repeated in most cases.PTA should be recommended as the first choice for patients with critical infragenicular limb ischemia.3. With regard to patients whom suffering from infragenicular limb ischemia, PTA is an effective therapy with minimal invasion. However, as to the long term patency, further study has to be done to investigates its effect in the future.更多还原