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目的评价忽略股浅动脉重建治疗慢性下肢动脉硬化闭塞症的临床意义。方法回顾分析2003年1月~2013年12月155例(220条患肢)股浅动脉重度狭窄、闭塞的下肢动脉硬化闭塞症的临床资料。根据对股浅动脉的处理方法,将患者分为股浅动脉重建组(107条患肢)和非重建组(113条患肢),比较2组患者的临床疗效。结果重建组近期(出院时)总有效率明显优于非重建组[70.1%(75/107)vs.46.0%(52/113),Z=-2.356,P=0.018],随访期内2组总有效率无统计学差异[53.3%(57/107)vs.57.5%(65/113),Z=-0.633,P=0.527]。2组保肢率无统计学差异[94.4%(101/107)vs.96.5%(109/113),χ~2=0.170,P=0.680]。重建组再次腔内治疗率更高[30.8%(33/107)vs.8.8%(10/113),χ2=16.903,P=0.000],费用更高[(34 658.7±8322.7)元vs.(17 036.6±1603.0)元,t=22.082,P=0.000]。2组围手术期病死率和并发症发生率无统计学差异[0 vs.0.9%(1/113),Fisher精确检验,P=1.000;1.9%(2/107)vs.1.8%(2/113),Fisher精确检验,P=1.000]。结论忽略股浅动脉重建治疗下肢动脉硬化闭塞症安全、有效、经济,应成为部分患者的首选治疗方法。
Objective To evaluate the clinical significance of neglecting superficial femoral artery reconstruction in the treatment of chronic lower extremity arteriosclerosis obliterans. Methods The clinical data of 155 cases (220 limbs) of superficial stenosis and occlusion of lower extremity atherosclerosis obliterans were retrospectively analyzed from January 2003 to December 2013. According to the treatment of superficial femoral artery, the patients were divided into superficial femoral artery reconstruction group (107 limbs) and non-reconstruction group (113 limbs). The clinical efficacy of the two groups were compared. Results The total effective rate (70.1% (75/107) vs 46.0% (52/113), Z = -2.356, P = 0.018] in the reconstructed group was significantly higher than that in the non-reconstructed group The total effective rate was no significant difference [53.3% (57/107 vs vs7.5% (65/113), Z = -0.633, P = 0.527]. There was no significant difference in the limb salvage rate between the two groups [94.4% (101/107) vs.96.5% (109/113), χ ~ 2 = 0.170, P = 0.680]. In the reconstruction group, the rate of endovascular treatment was higher again [30.8% (33/107) vs.8.8% (10/113), χ2 = 16.903, P = 0.000], higher cost [(34 658.7 ± 8322.7) 17 036.6 ± 1603.0) element, t = 22.082, P = 0.000]. There was no significant difference in perioperative mortality and complication rates between the two groups (0 vs 0.9% (1/113), Fisher’s exact test, P = 1.000; 1.9% (2/107) vs. 1.8% (2 / 113), Fisher exact test, P = 1.000]. Conclusion It is safe, effective and economical to ignore the superficial femoral artery reconstruction in the treatment of lower extremity arteriosclerosis obliterans. It should be the first choice of treatment for some patients.