【摘要】 目的　总结对严重下肢动脉缺血患者重建患肢血供的临床效果。方法　对 1995年 1月～ 2 0 0 0年 12月间重建肢体血液循环的 49例 5 6侧肢体进行回顾性分析。动脉闭塞分别位于近肾腹主动脉 -双髂动脉 ,腹主动脉 -双髂动脉 ,髂动脉 ,股动脉或股 -月国动脉。手术指征是间歇性跛行 ,静息痛和趾端坏疽。手术方式是股动静脉转流术 12例 14侧肢体 ,人造血管旁路搭桥术 2 8例 33侧肢体 ,动脉内膜切除及股深动脉补片成形术 5例 5侧肢体 ,一期截肢 4例。结果　术后随访平均 38个月。在重建血运的 5 2侧肢体中 ,4侧出现患肢坏疽而截肢 ;共截肢 8侧 ,累计截肢率为 14.3%。人造血管旁路搭桥术、动脉内膜切除及股深动脉补片成形状的肢体血流通畅率为 6 8.4%(2 6 / 38侧肢体 ) ,保肢率为 94.7% (36 / 38侧肢体 ) ;股动静脉转流术的保肢率为 85 .7% (12 / 14侧肢体 )。结论　血运重建是救治下肢动脉闭塞患肢的有效方法 ,应根据具体情况选择动脉旁路搭桥、动脉内膜切除及股深动脉补片成形或股动静脉转流术。动脉造影是重建手术成功的必要保证更多还原

【Abstract】 Objective To investigate the clinical effects of revascularization in lower extremity for severe ischemia. Methods Fifty six lower limbs with severe ischemia in 49 patients were evaluated retrospectively, who underwent surgical intervention from January of 1995 to December of 2000. By arteriography, the actual anatomic distributions of occlusive disease included infrarenal aorta bicommon iliac arteries, abdominal aorta bicommon iliac arteries, iliac artery, and femoral artery or femoropopliteal artery. The indication for surgery was disabling claudication, rest pain and gangrene. Fourteen limbs in 12 cases received arterialization of femoral venous system by artificial venous arterial fistula. Artificial vascular grafts were implanted in 33 limbs of 28 cases, endarterectomy and patch profundaplasty were performed in 5 limbs of 5 cases, and primary amputation was carried out in 4 cases. Results During 38 months follow up in average, 4 limbs were amputated within 52 revascularizated limbs, and accumulated amputation rate was 14.3%. Patency rate was 68.4% in arterial revascularization limbs (26/38 limbs), and limb survival rate was 94.7%(36/38 limbs) by procedure of artificial vascular grafts, endarterectomy and patch profundaplasty. Limb survival rate in procedure of artificial venous arterial fistula was 85.7%(12/14 limbs). Conclusion In treatment of severe lower extremity ischemia, the effective revascularization can be achieved by artificial vascular bypass, endarterectomy and patch profundaplasty, or arterialization of femoral venous system. Options in the surgical management should depend on individual. Arteriography is essential for revascularization and properly planning a practicable surgical approach.更多还原