Mesh C L, McCarthy W J, Pearce W H, Flinn W R, Shireman P K, Yao J S
Department of Surgery, Case Western Reserve University, Cleveland, Ohio.
Arch Surg. 1993 Jul;128(7):795-801; discussion 801-2. doi: 10.1001/archsurg.1993.01420190091012.
To analyze the perioperative morbidity and mortality, long-term patient survival, and patency characteristics of arterial bypass related to upper extremity ischemia.
This is a retrospective review of sequential patients undergoing upper extremity arterial bypass during a 15-year period at a single tertiary-care teaching hospital. Data are expressed in a 5-year life-table format and interpreted using log-rank analysis.
Seventy-four patients with upper extremity ischemia undergoing arterial bypass, which included 95 separate operations.
Operative morbidity and mortality, life-table survival, life-table bypass graft patency, and limb salvage are reported.
There was no operative mortality, and there was a single major amputation. Survival rate was 86% at 5 years, and overall patency rate was 61.2% at 5 years, with autogenous conduits superior at all sites compared with prosthesis (70.9% vs 37.7%). Secondary operation was inferior to primary bypass (66% vs 48%) and associated with higher morbidity (22% vs 5%). All far distal forearm prosthetic bypass grafts failed within 1 year.
Primary upper extremity bypass with venous conduit is a safe, durable procedure, after which prolonged patient survival can be expected.
分析与上肢缺血相关的动脉搭桥手术围手术期的发病率和死亡率、患者长期生存率以及通畅情况。
这是一项对一家三级护理教学医院15年间连续接受上肢动脉搭桥手术患者的回顾性研究。数据以5年生命表形式呈现，并采用对数秩检验进行分析。
74例接受上肢缺血动脉搭桥手术的患者，共进行了95次单独手术。
报告手术发病率和死亡率、生命表生存率、生命表搭桥血管通畅率以及肢体挽救情况。
无手术死亡病例，仅1例进行了大截肢手术。5年生存率为86%，5年总体通畅率为61.2%，自体血管在所有部位均优于人工血管（70.9%对37.7%）。二次手术效果不如初次搭桥（66%对48%），且发病率更高（22%对5%）。所有前臂远侧人工血管搭桥均在1年内失败。
采用静脉血管进行初次上肢搭桥手术是一种安全、持久的手术方法，术后患者有望获得较长的生存期。
