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目的探索治疗下肢动脉严重闭塞症的新方法。方法对3例下肢动脉严重闭塞症患者施行改良浅组静脉动脉化手术。患者平卧位,全身麻醉。首先在大腿部解剖游离有搏动、能够作为流出道动脉备用的股动脉;于踝部内侧,沿大隐静脉走向行约3 cm的纵行切口,游离大隐静脉,并检查管腔和管壁条件是否适合流入道重建。然后从大腿根部至小腿下1/3处切取大隐静脉作为移植材料,仔细检查大隐静脉是否渗漏。最后将大隐静脉反向,用6-0 proline缝线于股动脉作端侧缝合,完成流入道重建;远端移植段大隐静脉与踝部大隐静脉用7-0 proline作端侧缝合,完成流出道重建。结果3例中2例手术成功,临床症状明显改善;1例失败,作膝上截肢。结论只要大隐静脉长度和口径合适,改良浅组静脉动脉化手术的操作简便且疗效好,是下肢动脉严重闭塞症救肢的一种可选择的新手术方式。
Objective To explore a new method of treatment of severe occlusive disease of lower extremity. Methods Three cases of severe arterial occlusive disease of lower extremity underwent modified superficial venous arterialization. Supine patient, general anesthesia. First of all, free dissection in the thigh pulsation, can be used as outflow artery artery spare; in the medial malleolus, along the saphenous vein to about 3 cm longitudinal incision, free saphenous vein, and check the lumen and tube Wall condition is suitable for inflow tract reconstruction. Then from the thigh to the lower leg 1/3 of the great saphenous vein as a graft material, carefully check whether the great saphenous vein leakage. Finally, the great saphenous vein was reversed, 6-0 proline suture was used for sutured to the femoral artery to complete the reconstruction of the inflow tract. The distal saphenous vein and the great saphenous vein of the ankle were sutured with 7-0 proline to complete Outflow tract reconstruction. Results Of the 3 cases, 2 cases were successfully surgically treated, the clinical symptoms improved obviously, 1 case failed to make amputation on the knee. Conclusion As long as the length and caliber of the saphenous vein are appropriate, the modified simple venous arterialization is simple and effective. It is an alternative new surgical method for salvage of the severed occlusion of the lower extremity arteries.