準分子激光消蝕聯合藥物涂層球囊治療下肢動脈硬化閉塞癥的短期療效_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

祖力凱爾·艾尼瓦 , 楊建平 , 唐加熱克 ,  管圣

1. ;

Corresponding?author：

管圣, Email: Jyh610@sina.cn

Keywords：

準分子激光消蝕; 藥物涂層球囊; 下肢動脈硬化閉塞癥; 臨床療效

DOI：

10.7507/1007-9424.202308068

Video：

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目的評估準分子激光消蝕術（excimer laser ablation，ELA）聯合藥物涂層球囊（drug-coated balloon，DCB）治療下肢動脈硬化閉塞癥的療效及安全性。方法回顧性收集2021年9月至2022年4月期間新疆維吾爾自治區人民醫院血管外科收治且采用ELA聯合DCB治療的下肢動脈硬化閉塞癥患者的臨床病理資料，觀察手術成功率，術后第3天、第3、6、12個月時的踝肱指數、一期通暢率和保趾（肢）率。結果本研究共收集到40例患者，均為單下肢病變，男30例、女10例，年齡（71.9±10.9）歲。40例患者（40條肢體）手術成功率為100%，均未出現嚴重的術中并發癥。術后第3天、第3、6、12個月時的踝肱指數分別為0.87±0.09、0.82±0.12、0.78±0.10、0.76±0.15，較術前（0.34±0.13）均有明顯提高［均數差（95%可信區間）分別為 0.011（–0.549，–0.502）、0.013（–0.502，–0.447）、0.017（–0.473，–0.404）、0.016（–0.454，–0.385），t值分別為–46.70、–34.94、–25.55、–24.86，P值分別為<0.001、<0.001、0.035、0.048］。術后第3天、第3、6、12個月時的一期通暢率分別為100%（40/40）、97.5%（39/40）、90.0%（36/40）和82.5%（33/40），保肢（趾）率分別為95.0%（38/40）、92.5%（37/40）、92.5%（37/40）和87.5%（35/40）。結論從本組有限病例分析的結果提示，ELA聯合DCB治療下肢動脈硬化閉塞癥具有較好的安全性和良好的近期療效。

Citation： 祖力凱爾·艾尼瓦, 楊建平, 唐加熱克, 管圣. 準分子激光消蝕聯合藥物涂層球囊治療下肢動脈硬化閉塞癥的短期療效. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 85-88. doi: 10.7507/1007-9424.202308068 Copy

1.	Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ, 2018, 27(4): 427-432.
2.	Dake MD, Ansel GM, Jaff MR, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv, 2011, 4(5): 495-504.
3.	Jiang X, Ju S, Chen B, et al. Safety and effectiveness of excimer laser ablation combined with drug-coated balloon for atherosclerotic obliterans in the lower extremity. J Endovasc Ther, 2023, 30(5): 721-729.
4.	Stival LR, Figueiredo MN, Santhiago MR. Presbyopic excimer laser ablation: a review. J Refract Surg, 2018, 34(10): 698-710.
5.	Jongsma H, Bekken JA, de Vries JP, et al. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg, 2016, 64(5): 1503-1514.
6.	蔣小浪, 董智慧, 符偉國. 準分子激光消蝕在下肢動脈硬化閉塞癥治療中的應用及前景. 中華外科雜志, 2022, 60(12): 1041-1044.
7.	刁永鵬, 譚樹平, 蘭勇, 等. 準分子激光斑塊消蝕聯合藥物涂層球囊處理下肢動脈硬化閉塞癥. 中華普通外科雜志, 2019, 34(8): 663-666.
8.	喬冠宇, 蔣小浪, 陳斌, 等. 血管內超聲在準分子激光消蝕聯合藥物涂層球囊治療下肢動脈硬化閉塞癥中的應用價值. 中華外科雜志, 2023, 61(2): 150-155.
9.	Alfonso F, Rivero F, Cortese B. Excimer laser prior to drug-coated balloon treatment of in-stent restenosis. Int J Cardiol, 2022, 348: 47-49.
10.	Shammas NW, Shammas GA, Arikat L, et al. Five-year freedom from target-lesion revascularization using excimer laser ablation therapy in the treatment of in-stent restenosis of femoropopliteal arteries. J Invasive Cardiol, 2017, 29(6): 207-208.
11.	Dippel EJ, Makam P, Kovach R, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv, 2015, 8(1 Pt A): 92-101.
12.	李楊, 黃瑩, 郭連瑞, 等. 準分子激光消蝕聯合藥物涂層球囊治療股腘動脈支架內再狹窄的臨床療效. 中華老年心腦血管病雜志, 2019, 21(9): 934-938.
13.	Paulino Geisel P, Pantuso Monteiro D, de Oliveira Nascimento I, et al. Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes. J Vasc Surg, 2022, 75(2): 671-679.
14.	Catrina SB, Zheng X. Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 179-185.
15.	Peeters P, Keirse K, Verbist J, et al. Other endovascular methods of treating the diabetic foot. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.
16.	唐加熱克, 張傳陽, 楊建平, 等. 準分子激光銷蝕術治療糖尿病足膝下動脈病變的臨床療效分析. 中國醫師雜志, 2022, 24(12): 1776-1779.
17.	周思遠, 蔣小浪, 鞠帥, 等. 準分子激光消蝕治療糖尿病足膝下動脈病變效果分析. 中華外科雜志, 2022, 60(6): 599-605.

1. Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ, 2018, 27(4): 427-432.
2. Dake MD, Ansel GM, Jaff MR, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv, 2011, 4(5): 495-504.
3. Jiang X, Ju S, Chen B, et al. Safety and effectiveness of excimer laser ablation combined with drug-coated balloon for atherosclerotic obliterans in the lower extremity. J Endovasc Ther, 2023, 30(5): 721-729.
4. Stival LR, Figueiredo MN, Santhiago MR. Presbyopic excimer laser ablation: a review. J Refract Surg, 2018, 34(10): 698-710.
5. Jongsma H, Bekken JA, de Vries JP, et al. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg, 2016, 64(5): 1503-1514.
6. 蔣小浪, 董智慧, 符偉國. 準分子激光消蝕在下肢動脈硬化閉塞癥治療中的應用及前景. 中華外科雜志, 2022, 60(12): 1041-1044.
7. 刁永鵬, 譚樹平, 蘭勇, 等. 準分子激光斑塊消蝕聯合藥物涂層球囊處理下肢動脈硬化閉塞癥. 中華普通外科雜志, 2019, 34(8): 663-666.
8. 喬冠宇, 蔣小浪, 陳斌, 等. 血管內超聲在準分子激光消蝕聯合藥物涂層球囊治療下肢動脈硬化閉塞癥中的應用價值. 中華外科雜志, 2023, 61(2): 150-155.
9. Alfonso F, Rivero F, Cortese B. Excimer laser prior to drug-coated balloon treatment of in-stent restenosis. Int J Cardiol, 2022, 348: 47-49.
10. Shammas NW, Shammas GA, Arikat L, et al. Five-year freedom from target-lesion revascularization using excimer laser ablation therapy in the treatment of in-stent restenosis of femoropopliteal arteries. J Invasive Cardiol, 2017, 29(6): 207-208.
11. Dippel EJ, Makam P, Kovach R, et al. Randomized controlled study of excimer laser atherectomy for treatment of femoropopliteal in-stent restenosis: initial results from the EXCITE ISR trial (EXCImer Laser Randomized Controlled Study for Treatment of FemoropopliTEal In-Stent Restenosis). JACC Cardiovasc Interv, 2015, 8(1 Pt A): 92-101.
12. 李楊, 黃瑩, 郭連瑞, 等. 準分子激光消蝕聯合藥物涂層球囊治療股腘動脈支架內再狹窄的臨床療效. 中華老年心腦血管病雜志, 2019, 21(9): 934-938.
13. Paulino Geisel P, Pantuso Monteiro D, de Oliveira Nascimento I, et al. Evaluation of functional capacity and muscle metabolism in individuals with peripheral arterial disease with and without diabetes. J Vasc Surg, 2022, 75(2): 671-679.
14. Catrina SB, Zheng X. Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 179-185.
15. Peeters P, Keirse K, Verbist J, et al. Other endovascular methods of treating the diabetic foot. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.
16. 唐加熱克, 張傳陽, 楊建平, 等. 準分子激光銷蝕術治療糖尿病足膝下動脈病變的臨床療效分析. 中國醫師雜志, 2022, 24(12): 1776-1779.
17. 周思遠, 蔣小浪, 鞠帥, 等. 準分子激光消蝕治療糖尿病足膝下動脈病變效果分析. 中華外科雜志, 2022, 60(6): 599-605.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

準分子激光消蝕聯合藥物涂層球囊治療下肢動脈硬化閉塞癥的短期療效

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