摘要
目的 探讨糖尿病下肢缺血的外科治疗方法。 方法 78例 2型糖尿病 (T2DM )患者合并下肢动脉缺血的 95条肢体进行了外科手术治疗 ,其中动脉旁路移植术 76条下肢 ,占 80 %。主要方式为股动脉 动脉人工血管旁路移植 单支小腿动脉自体血管旁路移植术 (2 3 2 % )和动脉 小腿动脉旁路移植术 (2 1 0 % ) ;15例患者 16条下肢截肢处理 ,占 16 8% ;自体骨髓干细胞移植 3例 3条患肢 ,占 3 1%。 结果 75例 91条下肢的移植血管在出院时均保持通畅 ,通畅率为 10 0 % ;3例(4条下肢 )于术后死亡 ,围手术期病死率为 3 8% ,手术成功率为 96 2 %。术后踝肱指数 (ABI)为0 86～ 1 12 ,平均 0 94。自体骨髓干细胞移植的 3例患者 ,均达到避免截肢或降低截肢平面的目的。出院时足部创面愈合率 39 2 %。 结论 糖尿病性下肢缺血可以通过外科治疗 ,如下肢远端动脉旁路移植、腔内血管成型术、自体骨髓干细胞移植及适当平面的截肢等方法而获得较好的疗效 ,外科治疗不仅可以挽救肢体或降低截肢平面 ,而且可为足部创面的愈合提供较好的营养环境 。
Objective To investigate the effect of surgical t reatment on diabetic lower limb ischaemia. Methods All 78 cas es suffered from type 2 diabetes mellitus with 95 ischemic lower limbs received surgical treatment. Arterial bypasses were performed in 76 lower limbs, includi ng femoral-popliteal and popliteal-tibial arterial bypasses in 22 limbs (23.2 %). Popliteal-tibial arterial bypasses only were performed in 20 limbs(21.0%) . Amputations were performed in 16 limbs(16.8%) and autologous transplantation of bone-marrow stem cells in 3 limbs (3.1%). Results The b ypass grafts of 75 cases were patent on discharge(100%)and 3 cases (4 limbs) were dead(3.8%) for respiratory failure at 12 hours, on the 3th day and 7th d ay after operation. Rate of operation success was 96.2%. Ankle-brachial index (ABI) were from 0.86～1.12 with a mean of 0.94. Ulcer healing rate o f diabetic foot was 39.2% on discharge. Conclusions Diabetic lower limb ischaemia is a serious complication of diabetes. Good results can b e expected with surgical treatment including arterial bypass of lower limbs, tra nsluminal angioplasty with stent, autologous transplantation of bone-marrow ste m cell, and amputation. It can not only avoid amputation or lower the limb ampu tation level, but also improve blood circulation so as to promot foot ulcer heal ing and improve the quality of life.
基金
首都医学发展基金和北京市优秀人才资助项目( 2 0 0 2 10 13 )
