非创伤性截肢171例临床分析

Clinical analysis of 171 cases of nontraumatic amputation

[目的]探讨非创伤性截肢的疾病类型及其预后，并进行相关因素分析.[方法]收集中国医科大学附属第一医院血管外科自1998年1月至2008年12月截肢患者共171例，观察导致截肢的疾病种类，并进行多因素分析；观察疾病转归及术后健康状况.[结果]171例截肢患者年龄为17-90岁，平均为61岁；男性为132例（77.2%），女性为39例（22.8%）；下肢动脉硬化闭塞症为95例（55.6%），糖尿病足为25例（14.6%），动脉栓塞为31例（18.1%），血栓闭塞性脉管炎为5例（2.9%），腹主动脉疾病为7例（4.1%），主动脉或下肢动脉血栓形成为2例（1.2%），肢体恶性肿瘤及上肢缺血性疾病为6例（3.5%）.出院患者中切口完全愈合者为137例（80.1%），未愈合者为34例（19.9%）；住院期间死亡患者为6例（3.5%）.本组吸烟率、糖尿病及高血压患病率均高于普通人群；患糖尿病的截肢患者切口愈合较非糖尿病患者差；34例成功随访患者中截肢后安装义肢者仅为9例.[结论]缺血性疾病是导致非创伤性截肢的主要疾病，而年龄、高血压及糖尿病是下肢缺血性疾病的危险因素.截肢后患者生活及生存质量普遍受到影响，而早期诊断并积极治疗高血压及糖尿病可预防下肢缺血性疾病的发生及降低截肢率.

OBJECTIVE To investigate the types and its prognosis of diseases leading to amputation and analyze their correlation factors. METHODS It was retrospectively reviewed that 171 cases of nontraumatic amputation from January, 1998 to December, 2008 in Department of General Surgery, First Hospital of China Medical University, and analyzed that the types of diseases leading to nontraumatic amputation and multi-factors, and the prognosis of diseases and postoperative heath status were observed. RESULTS In 171 patients with amputation, the age was 17-90 years old（ average of 61 years old）, the male was 77. 2%（132/171）, female 22.8%（39/171）, and the diseases leading to amputation mainly included 55.6% （95/171） of lower extremity arteriosclerotic obliterans （ASO）, 14.6% （25/171） of diabetic foot, 18. 1%（31/171） of arterial embolism, 2.9% of thromboangiitis （Buerger＇ s disease）, 4.1% （7/171） of diseases of abdominal aorta, 1.2% （2/171） of thrombosis in aorta or lower extremity, and 3.5%（6/171） of limbs with malignant tumor. There were 80. 1% （137/171） 19.9%（34/171） of un-healing of incision in the patients discharged from hosp patients were died in hospital. The incidence rate of smoking, diabetes mell of completely healing and ital, and 3.5% （6/171） of itus and hypertension was significantly higher in the amputees than in the common population, and degree of incision healing was better in the non diabetic patients than in diabetic patients, and the patients used with artificial limbs after amputation were less than 26.5%. CONCLUSION Ischemic diseases of lower extremity are the main diseases leading to nontraumatic amputation, and age, hypertension, cigarette smoking and diabetes mellitus are main correlated risk factors predisposing to the ischemic diseases of lower extremity. To be early diagnosis and treat the hypertension and diabetes mellitus is correlated to prevent the ischemic diseases of lower extremity and decrease the rate of amputation.