应用显微外科技术治疗下肢动脉闭塞症蒋文萍赵少平刘德群【摘要】目的探讨下肢动脉闭塞症的血运重建方法及疗效。方法1998年7月～2005年3月,收治下肢动脉闭塞症29例。男22例,女7例,年龄22～86岁。其中血栓闭塞性脉管炎(thromboangiitisobliterans,TAO)9例,动脉硬化性闭塞症(arterialsclerosisobstruction,ASO)17例,糖尿病足(diabeticfoot,DF)3例。左下肢17例,右下肢11例,双下肢1例。测定踝肱指数(ankle2branchialindex,ABI)<0196例,<01523例。29例行彩色超声多普勒检查,其中ASO和DF患者均行MRA检查,提示动脉狭窄或闭塞部位:TAO股浅动脉下段3例,动脉5例,跖背动脉1例(双侧);ASO髂总动脉2例,髂外动脉4例,股动脉10例,动脉1例;DF均为股浅动脉。15例行数字减影血管造影检查提示有合适的流出道。根据动脉狭窄或闭塞部位和程度分别对11例患者行一期深组动静脉转流术;16例动脉旁路转流术;1例曾在外院行股总动脉血管旋切成形术者,作截肢处理;1例曾在外院行血管支架植入及人造血管移植术者,行动脉旁路转流术。结果术后TAO患者坏死组织去除后2例创面�期愈合,4例经换药后愈合,3例表浅坏死,坏死组织脱落后生长出正常组织;ASO患者中14例创面�期愈合,2例经换药愈合,1例曾在外院行血管支架植入及人造血管移植术者,术后血管闭塞,作截肢处理;DF患者中2例坏死组织去除后经换药愈合,1例术后症状加重,第2足趾进一步坏死后截肢。29例患者均获随访3个月～7年。术后疗效评价:治愈12例,明显改善10例,改善4例,无变化3例。ABI恢复正常12例,<01914例,<0153例。结论一期深组动静脉转流术和动脉旁路转流术是治疗下肢动脉闭塞症的有效方法,应用显微外科技术吻合血管可提高血管通畅率。【关键词】动脉闭塞动静脉转流动脉旁路转流中图分类号:R654.4R622.4文献标识码:AMICROSURGICALTREATMENTOFARTERIALOCCLUSIONINLOWEREXTREMITY�JIANGWenping,ZHAOShaoping,LIUDequn.DepartmentofHandSurgery,theSecondHospitalofTangshan,TangshanHebei,063000,P.R.ChinaCorrespondingauthor:JIANGWenping,E2mail:jiangwenping2005@126.com【Abstract】ObjectiveToinvestigatetheprocedureandclinicaleffectofrevascularizationforarterialocclusioninlowerextremity.MethodsFromJuly1998toMarch2005,29casesofarterialocclusionweretreatedbymicrosurgery.Of29cases,there22malesand7females,aging22286years,including9casesofthromboangiitisobliterans(TAO),17casesofarterialsclerosisobstruction(ASO)and3casesofdiabeticfoot(DF).Thelocationwastheleftin17cases,therightin11casesandbothsidesin1case.Allcaseswereinspectedbycolor2Dopplerultrasonicscanningbeforeoperation.ThecasesofASOandDFwerecheckedwithMRA.Theresultsofexaminationsshowedthatthelocationsofarteriostenosisandobstructionwere:in9casesofTAO,thedistalsuperficialfemoralarteryin3cases,poplitealarteryin5cases,bilateraldorsalmetatarsalarteryin1case;in17casesofASO,commoniliacarteryin2cases,externaliliacarteryin4cases,femoralarteryin10casesandpoplitealarteryin1case;andwereallsuperficialfemoralarteryin3casesofDF.DSAexaminationconfirmedthattherewasappropriateoutflowin15cases.Basingonthelocationandextentofthearterialocclusion,11casesweretreatedbytheprimarydeepveinarterializing,16casesbyarterialbypassdistributionand2casesofextensivecommoniliacarterialocclusionwereamputatedinthelevelof1�3distalthigh.ResultsThepostoperativedurationoffollow2upforallcaseswas3monthsto7years.In9casesofTAO,2healedbyfirstintentionafterdeterioration,4healedafterchangingdressingand3hadfreshsofttissuegrowthafterdebridedsuperficialsecondarynecrosis.In17casesofASO,13healedbyfirstintention,2healedafterchangingdressingand2wereamputated.In3casesofDF,2healedafterchangeddressinganddebrided,1wasaggravatedwiththesecondtoenecrosis.ConclusionPerformingprimarydeepvein2arteriolizationandarterialby...
