糖尿病对动脉旁路移植术治疗慢性肢体缺血的影响

Influence of diabetes mellitus on results of infrainguinal artery bypass for chronical ischemia of the lower extremities

目的评价糖尿病对动脉旁路移植术治疗慢性下肢缺血疗效的影响。方法回顾性分析2002年2月至2005年10月因慢性下肢缺血而行下肢动脉旁路移植术的临床资料,进行病例对照研究。82例(86条肢体)进行下肢血管重建,其中糖尿病患者(diabetes mellitus group,DM组)42例(44条肢体),非糖尿病患者(nondiabetes mellitus group,NDM组)40例(42条肢体)。随访1-48个月,比较两组旁路移植物的通畅率,保肢率及围手术期死亡率。结果DM组年龄(68±10)岁,NDM组为(63±12)岁,两组间差异有统计学意义(P=0．025)。围手术期DM组死亡率为4．8％,NDM组死亡率是2．5％,两组死亡率差异无统计学意义(P=1．000)。第4年的累积首次通畅率DM组为44％,NDM组为64％(P=0．112)。累积二期通畅率DM组为69％,NDM组为66％,两组差异无统计学意义(P=0．083)。DM和NDM组第4年累积保肢率分别为68％,66％(P=0．114)。结论与无糖尿病的下肢动脉硬化闭塞症相比,糖尿病并不增加动脉旁路术围术期的死亡率,不降低移植物累积通畅率及保肢率。

Objective To evaluate the efficiency and safety of infrainguinal arterial bypass in diabetic ischemia of the lower extremities. Method Eighty-two consecutive patients undergoing lower extremity arterial reconstruction from 2002 to 2005 were divided into diabetes group （ DM ） and nondiabetes group （NDM）. Graft patency, limb salvage, and perioperative complications were compared between the two groups. Results There were 82 patients receiving 86 grafts, 44 grafts （51.2%） in patients with diabetes （DM group） and 42 （48.8%） in nondiabetic patients （ NDM group）. Average age of the DM group was （68 ± 10） years, vs. （63 ± 12） years of NDM group （ P = 0. 025 ）. In-hospital perioperative mortality was 3.7% （ DM group 4. 8% vs. NDM 2.5% ,P = 1. 000）. Cumulative primary and secondary graft patency in 4 year was 44% in DM group and 64% in NDM group, P = 0. 112 and 69% in DM group, 66% in NDM group, P = 0. 083 ） , respectively. The 4 year overall limb salvage rate was not statistically defferent （DM group, 68% ; NDM group, 66% ; P = 0. 114）. Conclusions Diabetes mellitus does not influence perioperative mortality, graft patency, or limb salvage rates after lower extremity arterial bypass.