下肢股-腘动脉旁路移植附加小腿大隐静脉动脉化治疗严重糖尿病足八例分析

Treatment of diabetic foot by femoropopliteal bypass grafting with great saphenous vein in situ arterializatlon in the calf

目的探讨下肢股-腘动脉旁路移植附加小腿大隐静脉动脉化治疗严重糖尿病足的疗效。方法分析2004年9月至2006年8月治疗的8例糖尿病足患者的临床资料,糖尿病史平均为10.5年。8例8条患肢均有疼痛,足部溃疡有3例,足部坏疽5例;ABI在0.1～0.5之间有4例,ABI为0有4例;7例患者接受皮肤温度检查,平均为28.6℃。所有患者下肢股浅动脉闭塞;腘动脉部分通畅;6例小腿动脉（胫前动脉、胫后动脉和腓动脉）完全闭塞,2例小腿动脉大部分闭塞,有部分主干通畅,但是管径细无法行动脉旁路移植。8例均先行股-腘动脉旁路移植,然后将小腿近段的大隐静脉的分支全部结扎,保留踝部的静脉分支,将小腿近端大隐静脉切断并将其瓣膜破坏,然后再与股-腘动脉旁路移植血管的远段吻合在一起。结果手术全部成功。足部疼痛缓解5例,明显减轻2例,1例足部疼痛无缓解。7例的皮肤温度平均增加到35.8℃。ABI（ankle brachial index）平均增加了0.42。3例足部溃疡均有明显缩小;5例坏疽创面中3例的感染得到了控制。随访时间平均为10个月,5例足部疼痛缓解,1例仍感疼痛,2例足部疼痛复发;3例溃疡创面愈合;5例坏疽的下肢中3例行膝下截肢,2例经过清除足部坏疽组织后保留足根。结论对于糖尿病足流出道严重不良造成的严重下肢缺血者,在无法进行下肢动脉旁路移植、下肢动脉介入术,或者下肢动脉旁路移植、介入手术失败者,股动脉-腘动脉人工血管-小腿大隐静脉动脉化是救肢的治疗方法之一。

Objective To explore the effectiveness of femoropepliteal bypass grafting with great saphenous vein in situ arterialization in the calf in the treatment of severe diabetic foot. Method Eight severe diabetic foot in 8 patients were treated in our hospital during recent 2 years. Foot pain occurred in all eight patients, foot ulcer in 3 patients and gangrene in 5 patients. ABI were between 0. 1 - 0. 5 in four patients and 0 in the other 4 patients. Skin temperature was recorded in 7 patients with an average of 28.6℃. Superficial femoral artery occlusion was seen and no runoff artery could be found in the leg of all the patients. Consequently, femoropepliteal bypass grafting with great saphenous vein in situ arterialization in the calf was recruited in these patients. Results Surgery was successful in all the 8 cases. Foot pain relieved in 5 patients, reduced in two patients, did not change in one patient. Skin temperature were with an average of 35.8℃ in 7 patients. ABI was increased with an average of 0.42. Foot ulcer reduced in 3 patients; Infections in 3 patients out of 5 patients with foot gangrene were under control after operation. Within a follow-up period of 10 months in average, foot pain relieved in 5 patients, remained in one patient, recurred in 2 patients; Foot ulcer healed in 3 patients; Of 5 patients with necrotic limbs, 3 patients underwent below knee amputation and 2 patients underwent debridement resulting in successful preservation of the heel. Conclusion In the treatment of diabetic foot, femoropepliteal bypass grafting with great saphenous vein in situ arterialization in the calf is a practical choice in cases in which no below knee arterial restoration is feasible.