下肢动脉硬化闭塞症侧支循环流出道的解剖学特点及临床应用初探胡骥琼 王道明 司春强 薛清泉 梁双超【摘 要】 目的 下肢动脉粥样硬化闭塞症（arterial sclerosis obstruction，ASO）末期常无远端流出道，对末期ASO患者膝上截肢的离断标本行血管灌注，通过解剖学研究评估侧支流出道构建的可能性及临床应用前景。
方法 在10例自愿捐赠的膝上截肢新鲜离体标本上向动脉内灌注红色乳胶，解剖观察腘动脉、胫前动脉、胫后动脉的病理改变，以及这些主干动脉侧支分布的规律。
2005年9月－2007年4月，收治5例ASO患者，均为单侧。
其中男3例，女2例；年龄68～81岁。
均有6个月静息痛病史。
下肢DSA示股动脉、腘动脉及分支均不显影，B超示腘动脉及分支基本闭塞，行腘动脉及分支探查、血循环重建术。
结果 解剖学实验结果：腘动脉、胫后动脉、胫前动脉管壁僵硬，动脉粥样斑块填满管腔。
腘动脉及分支发出的侧支中，腓肠动脉开口于主干动脉的几率最大。
所有侧支在膝周构建的侧支循环稀疏，而在小腿肌群内可形成相对丰富的侧支循环。
临床应用结果：5例手术均顺利，术后皮温逐渐增高，血氧饱和度术前为0，术后6 h逐渐达90%～100%。
获随访3～12个月，患者感觉下肢症状明显改善，静息痛消失，下肢溃疡逐渐愈合。
B超示腘动脉吻合口处血流大部进入侧支循环，远侧胫前、胫后动脉的血流量并不多。
结论 通过临床解剖发现，侧支流出道的构建是可行的，临床应用结果提示这一方法是解决晚期ASO患者的一种有效途径。
【关键词】 动脉粥样硬化闭塞症 流出道 侧支循环 应用解剖中图分类号： R543.5 R322.1 文献标志码：AANATOMY AND CLINICAL APPLICATION OF BYPASS CIRCUIT OUTFLOW TRACT OF ARTERIAL SCLEROSIS OBSTRUCTION/HU Jiqiong, WANG Daoming, SI Chunqiang, XUE Qingquan, LIANG Shuangchao. Department of Vascular Surgery, Yijishan Hospital, Wannan Medical College, Wuhu Anhui, 241001, P.R.China. Corresponding author: HU Jiqiong, E-mail: wuhuhujiqun@【Abstract】Objective To evaluate the possibil ity of collateral outflow tract of arterial sclerosis obstruction （ASO）and the prospect of cl inical appl ication.Methods The red emulsion was infused into the arteries of the above knee amputation of10fresh specimens.Then the pathological changes of the anterior tibial artery,posterior tibial artery and the popliteal artery,and the contribution of these bole artery branch were observed.From September2005to April2007,5 patients with ASO were treated,unilateral lower limb was involved in all cases.There were3males and2females,aged68-81 years.The arteriography and Color Doppler ultrasound of lower l imbs showed that the femoral artery and the popl iteal artery and the branches had no development.The exploratory operation on the popliteal artery and the branches was carried out.Results The walls of the anterior tibial artery,posterior tibial artery,and the popliteal artery were stiff and the lumens were filled with atheromatous plaque.The sural arteries opening to the bole artery was frequent.The collateral circulation at the knee perimeter was raritas rather affluent at the muscle group.All of the operations were successful,the skin temperature increased gradually after operation,and the degrees of blood oxygen saturation increased to90%-100%at6hours from0before operation.After a follow-up of3to12months,the symptom improved obviously,rest pain disappeared,lower limb ulcer healed.The Color Doppler ultrasound showed that most of the blood flow at the anastomotic stoma ejected into bypass circuit, and the blood flow at the distally posterior tibial artery and anterior tibial artery was little.Conclusion The collateral outflow tract construction is feasible,it is an effective path after clinical verification to solve the advanced stage ASO.【Key words】 Arterial sclerosis obstruction Outflow tract Collateral circulation Application anatomy下肢动脉粥样硬化闭塞症（arterial sclerosis ob-struction，ASO）是血管外科常见疾病之一。
