267例主髂动脉闭塞的手术治疗经验

目的 探讨肾动脉开口水平以下腹主动脉闭塞及髂动脉闭塞的手术方式选择及治疗经验。方法 回顾性分析267例主、髂动脉闭塞患者的临床资料。结果 267例患者全部行手术治疗。行腹主动脉－髂（股）动脉人工血管转流术145例,髂动脉－股动脉人工血管转流术40例,股动脉－股动脉人工血管转流术45例,腋动脉－股动脉人工血管转流术37例。总有效率为96．5％,围手术期病死率为3．5％。267例中178例得到随访,平均随访时间5年9个月,人工血管通畅率为82．0％。结论 符合正常血液动力学手术的主要术式是腹主动脉－（双）髂、股动脉人工血管转流术,对于年老、体弱者,特别是全身一般状况较差,伴有冠心病、高血压、脑动脉硬化、脑梗塞等慢性疾病的患者,应采用腋动脉－（双）髂股动脉人工血管转流术或股动脉－股动脉人工血管转流术,可明显减低手术病死率。

Management of arterial occlusive diseases of abdominal aorta and iliac artery: experience with 267 cases

Objective To study the surgical treatment of infrarenal aortic and iliac arterial occlusive disease. Method We analized 267 patients with arterial occlusive diseases of the abdominal aorta and iliac artery retrospectively. Results All the patients were treated by surgery including aortic iliac bypass in 145 patients, iliac femoral bypass in 40, femoro femoral bypass in 45, and axillo femoral bypass in 37. Their total effective rate and perioperative motality were 96 5% and 3 5%, respectively. Of the 267 patients, 178 were followed up. The patency rate of prosthesis was 82 0%. Conclusions Extra anatomical bypass is a procedure of choice for high risk patients, especially for those chronic patients with coronary heart disease, hypertension, cerebral arterial atherosclerosis, and brain infarction.