糖尿病下肢缺血膝下动脉重建临床效果的初步评价

Preliminary evaluation of clinical effects of below-knee arterial bypass on diabetic lower limb ischemia

目的评价糖尿病下肢缺血患者膝下动脉旁路移植术的中远期通畅率。方法回顾性分析2001年11月至2006年12月因糖尿病下肢缺血行膝下动脉旁路移植的患者5l例共56条肢体。其中男性35例，女性16例，平均年龄68岁，平均缺血时间26个月，平均糖尿病史11年。静息痛26例，足部溃疡坏疽25例。所有患者均行至小腿（胫前、胫后或腓）动脉的旁路移植手术。应用Kaplan—meier生存分析法评价中远期通畅情况，并按照手术方式和流出道血管的不同，进一步采用Log—rank检验比较其对通畅率的影响。结果平均随访23个月，失访率15％。随访患者总体1年和5年的一期通畅率为68％和54％，二期通畅率为70％和60％，保肢率为69％和65％，存活率为82％和60％。股-腘动脉人工血管－小腿动脉自体静脉旁路移植、股／腘－小腿动脉人工血管旁路移植和股／腘-小腿动脉自体静脉旁路移植的1年（3年）的通畅率分别为70％（50％）、33％（33％）和70％（70％）；以胫后、胫前和腓动脉作为流出道的1年（4年）通畅率分别为65％（60％）、80％（53％）和77％（66％）；经Log—rank检验，以上各组间差异均无统计学意义（P〉0．05）。结论糖尿病下肢缺血旁路移植手术的血管桥应首选自体静脉无论采用胫前、胫后还是腓动脉作为流出道，其中远期通畅率均是可以接受的。

Objective To evaluate medium-long term patency of below-knee bypass on patients who suffered from diabetic lower limb ischemia. Methods Clinical and follow-up data of 51 patients was retrospectively analyzed who underwent 56 below-knee bypass because of diabetes from November 2001 to December 2006. There were 35 male and 16 female with an average age of 68 years. They endured 26 months ischemic time lag in average, and had suffered from diabetes for 11 years. All of the patients were performed bypass to below-knee （posterior tibial, anterior tibial or peroneal） arteries. Kaplan-meier method was applied. The subgroups of different operative methods and different out-flow vessels were compared by Log-rank tests. Results An average follow-up time of 23 months was achieved, and lost-follow-up rate was 15%. The total 1- and 5- year primary patent rates were 68% and 54% respectively, secondary patent rate were 70% and 60% respectively, limb salvage rates were 69% and 65%, survival rates were 82% and 60% ~ One year （ 3 years） of patent rate （s） of operative method subgroups of femoral-popliteal-infrageniculate bypass with composite grafts, femoral/popliteal-infrageniculate bypass with artificial grafts and femoral/ popliteal-infrageniculate bypass with autologous veins were 70% （50%）, 33% （33%） and 70% （70%） respectively. One year （4 years） of patent rate （ s ） of out-flow vessel subgroups of posterior tibial artery, anterior tibial artery and peroneal artery were 65% （60%）, 80% （53%） and 77% （66%） respectively. However, both subgroups did not show any statistic differences by log-rank tests. Conclusions Partial or whole autologous veins as bypass grafts should be chosen when infrageniculate bypass is considered in diabetic patients. Considerable patent rates are acceptable no matter what kinds of out-flow vessels are chosen.