本文選題：主髂動(dòng)脈閉塞癥 + 血管腔內(nèi)技術(shù)�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:腔內(nèi)血管技術(shù)使主髂動(dòng)脈疾病的治療再上一臺(tái)階,隨著技術(shù)的進(jìn)步,包括高質(zhì)量的影像技術(shù)、精密的器材、各種各樣的支架及球囊的出現(xiàn)及不斷完善,使血管腔內(nèi)治療的結(jié)果令人欣慰。與傳統(tǒng)的血管旁路移植等外科手段的結(jié)果相比,血管腔內(nèi)技術(shù)有其本身的優(yōu)勢。因此,血管外科醫(yī)師們開始傾向于血管腔內(nèi)治療。目前,絕大多數(shù)的主髂動(dòng)脈病變采用血管腔內(nèi)技術(shù)治療,而且隨訪結(jié)果令人滿意。隨著技術(shù)的不斷更新,對(duì)于嚴(yán)重主髂動(dòng)脈病變的復(fù)雜病例,血管外科醫(yī)師也能夠通過放置血管內(nèi)支架的血管腔內(nèi)技術(shù)及或開放手術(shù)或兩者相結(jié)合的手段進(jìn)行治療。為了更進(jìn)一步證明血管腔內(nèi)技術(shù)在治療主髂動(dòng)脈疾病的臨床結(jié)果。根據(jù)泛大西洋協(xié)作組織(Trans—Atlantic Inter—Society Consensus,TASC II)動(dòng)脈疾病治療指南,參考相關(guān)文獻(xiàn),探究我單位應(yīng)用血管腔內(nèi)技術(shù)治療TASC C、D型主髂動(dòng)脈病變的療效。方法及結(jié)果:根據(jù)我單位2012年1月至2016年7月期間的資料�；仡櫺匝芯恳匝芮粌�(nèi)技術(shù)治療主髂動(dòng)脈閉塞性疾病,分析其療效。依據(jù)泛太大西洋協(xié)作組織(Trans—Atlantic Inter—Society Consensus,TASCII)動(dòng)脈疾病治療指南,我單位在上述時(shí)間范圍內(nèi)收治TASC C、D型共367例,其中TASC C型244例,TASC D型123例,針對(duì)不同病例,予球囊血管成形術(shù)32例、支架200例:自膨式支架113例及覆膜支架87例、內(nèi)膜下血管成形術(shù)共13例、內(nèi)膜剝脫術(shù)聯(lián)合血管腔內(nèi)技術(shù)共77例、其他雜交術(shù)45例。對(duì)于髂總動(dòng)脈閉塞,術(shù)中通過血管造影,主動(dòng)脈分叉處予自膨式支架或覆膜支架重建,其直徑在8-10mm;對(duì)于主動(dòng)脈狹窄病例,支架直徑選擇20-25mm。所有病例術(shù)中手術(shù)過程順利,且殘余狹窄率皆低于30%,而且其并發(fā)癥2.4%。術(shù)后采用多普勒超聲和必要時(shí)血管造影進(jìn)行隨訪,隨訪結(jié)果表明其第12、第18、第30、第42、第54個(gè)月的一期通暢率分別為97.2/95.8、95.2/94.6、85.5/84.3、79.3/77.8、77.6/75.5(TASC CD),二期通暢率均為100%。結(jié)論:血管腔內(nèi)技術(shù)日新月異,是主髂動(dòng)脈閉塞疾病安全、有效的治療方案;對(duì)于復(fù)雜單側(cè)髂動(dòng)脈閉塞、對(duì)側(cè)髂動(dòng)脈高度狹窄、或者合并腎下主動(dòng)脈閉塞的閉塞的病變,皆能通過極高的技術(shù)成功率獲得滿意的治療效果;綜合目前的隨訪結(jié)果和并發(fā)癥等方面,可首選血管腔內(nèi)技術(shù)治療TASC C、TASC D型主髂動(dòng)脈疾病。
[Abstract]:Objective: endovascular techniques have brought the treatment of major iliac artery diseases to a new stage. With the development of technology, including high quality imaging technology, precise equipment, various stents and balloon, The result of endovascular treatment is gratifying. Compared with the results of traditional surgical methods such as vascular bypass grafting, endovascular technique has its own advantages. As a result, vascular surgeons began to favour endovascular therapy. At present, most of the main iliac artery lesions are treated by endovascular technique, and the follow-up results are satisfactory. With the development of new techniques, vascular surgeons can also treat complex cases of severe major iliac artery disease by endovascular technique with stent placement, or open surgery or combination of both. To further demonstrate the clinical results of endovascular technique in the treatment of main iliac artery disease. According to the Trans-Atlantic Inter-Society Consensus TASCII-based guidelines for the treatment of arterial diseases, and with reference to relevant literature, we explored the efficacy of endovascular technique in the treatment of TASC Con D main iliac artery lesions. Methods and results: according to the data from January 2012 to July 2016. A retrospective study was conducted to evaluate the efficacy of endovascular technique in the treatment of major iliac artery occlusive diseases. According to the Trans-Atlantic Inter-Society Consensus-TASCII-based guidelines for the treatment of arterial diseases, 367 cases of TASC type C D were treated in our unit, including 244 cases of TASC C type, 123 cases of TASC D type. Balloon angioplasty was performed in 32 cases, stent in 200 cases: self-expandable stent (113 cases) and covered stent (87 cases), subintimal angioplasty (13 cases), endarterectomy combined with endovascular technique (77 cases), and other hybridization (45 cases). For common iliac artery occlusion, the diameter of self-expandable stents or covered stents was 8-10 mm by angiography, and the diameter of stent was 20-25 mm in aortic stenosis cases. The operative procedure was smooth and the residual stenosis rate was lower than 30% in all cases, and the complications were 2.4%. Doppler ultrasound and angiography were used to follow up the patients. The results showed that the patency rates of the 12th, the 18th, the 30th, the 42nd and the 54th month were 97.2 / 95.895 / 95.2 / 84.3 / 79.877.6and 75.5TASC respectively, and the patency rate of the second stage was 100. Conclusion: endovascular technique is a safe and effective treatment for the disease of main iliac artery occlusion, for complicated unilateral iliac artery occlusion, high contralateral iliac artery stenosis, or combined with subrenal aortic occlusion. The results of follow-up and complications showed that endovascular technique was the first choice for the treatment of TASC CTASC D main iliac artery disease.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.4

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