在严重下肢缺血情况下采用人工假体复腘胫骨段效果的改善

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目的:目的分析人工假体在严重下肢缺血患者行股骨远端腘窝及胫骨旁路手术的近期及远期效果。

材料与方法:在2009-2017年期间,下肢慢性动脉供血不足严重危重阶段109例在D.D.Pletnev City Clinical Hospita国家预算机构的莫斯科大学外科诊所接受了手术。他们进行了股骨远端腘动脉旁路移植术或股骨胫骨旁路移植术,使用人工植体的聚四氟乙烯(PTFE)。33例(30.3%)患者搭桥手术是用人造假体进行的,76例(69.7%)采用外植体结合自体静脉,44例(40,4%)采用人工假体+自体静脉,32例(29.3%)采用根据补片或袖口类型进行远侧吻合口。两组患者中有14例(12.8%)在干预过程中辅以术中小腿动脉球囊血管成形术。对手术后5年的长期结果进行评估。Kaplan-Meyer生存分析用于计算结果。

结果:人工假体5年累计通行性为42.9%。然而,使用假体联合自体静脉,其采用联合分流或远侧吻合口,可显著提高累计通行性(54.5%),以及保肢功能(83.6%)。

结论。所获得的结果允许推荐在没有完全自体静脉发生的情况下,使用人工假体联合远侧吻合口的自体静脉成形术,或者把假体和小的自体静脉结合起来。为了改善长期效果,有必要对此类分流进行长期定期监测,并及时实施反复干预。

作者简介

Andrey Matyushkin

Russian National Research Medical University named after N. I. Pirogov; City Clinical Hospital named after D.D. Pletnev

编辑信件的主要联系方式.
Email: iplobachev@yandex.ru
ORCID iD: 0000-0002-4112-7732
SPIN 代码: 5794-6214
Researcher ID: B-7734-2018

MD, professor of the department of faculty surgery of the pediatric faculty, MD, head of the department of vascular surgery

俄罗斯联邦, Moscow

Alexey Lobachev

City Clinical Hospital named after the Bakhrushin brothers

Email: iplobachev@yandex.ru
ORCID iD: 0000-0002-1361-9967

MD, PhD, Head of the Surgical Department of the Polyclinic

俄罗斯联邦, Moscow

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