超声血栓消融及小球囊介入方法治疗糖尿病下肢动脉闭塞硬化症及足坏疽

Ultrasound ablation combined with balloon angioplasty for treatment of diabetic patients with arteriosclerosis obliteration of lower extremity and diabetic foot

目的:观察血管内超声血栓消融术配合小球囊、支架等介入治疗方法配合内科综合治疗糖尿病合并下肢动脉闭塞硬化症及糖尿病足的临床疗效。方法:对47例糖尿病合并下肢动脉闭塞硬化症患者共60条肢体在内科综合治疗如抗感染、扩血管、改善循环、抗凝的前提下行超声血栓消融术与小球囊、支架等介入治疗。结果:47例60条患肢术中下肢动脉通畅率达93.3%;术后1个月以及术后3个月测定的下肢动脉MRI、超声、踝/肱指数(ABI)、下肢皮肤温度以及肢体凉、麻、痛、皮肤苍白或发绀的缺血状况较术前有不同程度改善,足伤口愈合时间缩短。结论:糖尿病下肢动脉闭塞硬化症合并足坏疽的患者,在传统内科综合治疗基础上,将先进的超声血栓消融技术与小球囊、支架等介入治疗的手段相结合,可以使闭塞的大血管再通,明显改善血供,为糖尿病足坏疽的治愈提供良好的血液循环条件。

Objective： To observe the effect of ultrasound ablation combined with the balloon angioplasty in treatment of patients with arteriosclerosis obliteration of lower extremity and diabetic foot. Methods： The 60 limbs of 47 patients with arteriosclerosis obliteration of lower extremity （AOLE） were treated comprehensively by anti-infection,enlarging blood vessel, improving circulation,and anticoagulation; they also received ultrasound ablation, balloon angioplasty and stenting. Results： The patent rate of the 60 limbs was 93.3 %. One month and 3 months after treatment with ultrasound ablation combined with balloon angioplasty, the MRI of artery of lower extremity, ultrasound manifestation,ankle-brachial index （ABI）,the skin temperature of lower extremity and the sense to coolness, numbness, pain,ochrodermia or cyanosed were all improved to some extents compared with those before treatment. The healing of the diabetic foot was also accelerated. Conclusion： Ultrasound ablation combined with the balloon angioplasty and stenting, together with conventional treatment like anti-infection, anticoagulation, enlarging blood vessel, improving circulation, can reopen the occluded blood vessels and improve blood supply, thus provides a favourable condition for treatment of diabetic foot.