吴中俭　谷涌泉　齐立行

[摘要] 目的 對比分析单纯球囊扩张与联合药物涂层支架置入治疗膝下动脉闭塞性病变的效果。 方法 回顾性分析2013年3月～2015年10月首都医科大学宣武医院收治的126例（139条肢体）行腔内治疗的膝下动脉闭塞性疾病患者的临床资料。所有病变均先行球囊扩张治疗，其中32条肢体在膝下动脉内增加了药物涂层支架置入治疗，术后观察患者症状的改善，踝肱指数的变化，血管超声下的影像学改变，保肢率以及近期通畅率等。 结果 8例（10条肢体）手术失败，成功者踝肱指数（ABI）由术前的（0.39±0.13）提高至术后3 d的（0.82±0.16）（P < 0.05）。总体的膝下动脉血流通畅率在术后6个月为83.5%（101/121），术后12个月为69.5%（57/82），其中单纯行球囊扩张术的通畅率分别为83.3%（75/90）和71.0%（44/62），行支架置入术的通畅率分别为83.9%（26/31）和65.0%（13/20），单纯行球囊扩张与行支架置入术后的疗效比较，差异无统计学意义（P > 0.05）。 结论 伴有药物涂层支架置入的腔内介入治疗与单纯球囊扩张均可应用于治疗膝下动脉闭塞性疾病，两者的短期疗效是相近的。在治疗膝下动脉病变过程中若有严重的影响血流的并发症时还应考虑行支架置入，以改善患肢血运，避免并发症，提高保肢率。

[关键词] 腔内介入治疗；膝下动脉；支架置入；球囊扩张

[中图分类号] R542.22 [文献标识码] A [文章编号] 1673-7210（2017）08（a）-0066-03

[Abstract] Objective To compare and analyze the efficacy of balloon dilatation alone and combination with drug eluting stent implantation in the treatment of infrapopliteal arterial occlusive disease. Methods The clinical data of 126 patients （139 limbs） with infrapopliteal arterial occlusive disease and underwent the endovascular treatment from March to 2013 and October 2015 in Xuanwu Hospital， Capital Medical University were retrospectively analyzed. All the cases received balloon dilatation therapy at first， and 32 limbs among them received the drug-eluting stent implantation in infrapopliteal artery. After the surgery， the improvement of symptoms， the change of ankle brachial indexes， changes of vascular ultrasonic images， the limb salvage rate and recent patency rate and so on were observed. Results 8 patients （10 limbs） failed， and the ankle brachial index （ABI） of successful cases increased from before surgery （0.39±0.13） to 3 days after the surgery （0.82±0.16） （P < 0.05）. Overall infrapopliteal arterial patency rate 6 months after the operation was 83.5% （101/121）， and 12 months after operation was 69.5% （57/82）， the patency rates of those with balloon dilatation alone were 83.3% （75/90） and 71.0% （44/62） respectively， the patency rates of those with stent implantation were 83.9% （26/31） and 65.0% （13/20） respectively， there were no statistical difference in efficacy between balloon dilation alone and stent implantation 6 months and 12 months after operation （P > 0.05 ）. Conclusion Both endovascular interventional therapy with drug eluting stent implantation and balloon dilatation alone can be used to treat infrapopliteal arterial occlusive disease and they are with similar short-term efficacy. If there are severe complications that affect the blood flow in the treatment of infrapopliteal arterial disease， stent implantation should be considered to improve limb blood flow， avoid the complications and improve the limb salvage rate.endprint

[Key words] Endovascular interventional therapy； Infrapopliteal artery； Stent implantation； Balloon dilatation

近年来我国下肢动脉硬化闭塞症累及膝下的患者逐年增加，对其保守治疗效果不佳[1-2]，介入治疗要优于保守治疗[3-6]，并较旁路移植治疗并发症少[7]，现普遍认为经皮腔内血管成形术在膝下动脉硬化闭塞症的治疗中疗效安全、确切[8]，而药物涂层冠脉支架置入在球扩不理想或球扩后出现动脉夹层等并发症的情况下逐渐得到较多应用。本文回顾性分析首都医科大学宣武医院（以下简称“我院”）下肢动脉硬化闭塞症累及膝下的患者的临床资料，对比分析单纯球囊扩张与联合药物涂层支架置入治疗膝下动脉闭塞性病变的疗效，为膝下动脉闭塞性疾病的治疗提供一定的参考。……