糖尿病足的血管腔内治疗疗效评估

Endovascular treatment of diabetic feet

目的探讨糖尿病足(DF)不同病变部位和性质选择不同介入治疗方法的疗效分析。方法糖尿病足患者52例(65肢),先行DSA测定病变范围及程度,按病变部位狭窄段分为髂动脉、股动脉及膝下动脉,按病变程度分为狭窄性病变及闭塞性病变。根据不同类别采用经皮腔内血管球囊成形术(PTA组)、球囊成形联合内支架植入术(支架组)及经股动脉局部药物灌注术(灌注组)治疗,观察患者术中及术后并发症、技术成功率及临床疗效。结果经造影证实65侧下肢动脉均存在动脉狭窄/闭塞性病变,病变范围1.3～25.6 cm。病变部位在髂动脉、股动脉、膝以下动脉分别19、31、15个肢体。根据狭窄程度及部位分别采用FTA术、球囊成形+支架植入术、局部药物灌注(20、29、16个肢体),技术成功率100%,没有明显并发症出现。术后7天踝肱指数(ABI)由术前的(0.40±0.16)上升至(0.69±0.15)。结论采用微创介入治疗DF具有安全、可靠等特点。根据DF不同类型和血管病变部位采用相应的介入治疗方式是保证疗效的关键。

Objective To determine the clinical efficacy of interventional therapy for patients with diabetic feet （DF）. Methods Digital subtraction angiography （DSA） was performed on fifty-two patients （sixty-five lower limbs） with DF. The patients were selected .for percutaneous endovascular balloon angioplasty （PTA group）, balloon angioplasty and stent implantation （stent group） or transfemoral artery local drug perfusion （perfusion group） treatment according to the location of stenosis or occlusion in the iliac artery, femoral artery or in the arteries below the knee. The procedural success rates, complications and clinical improvement were analyzed. Results Sixty-five lower extremity arterial steno- sis/occlusive lesions were confirmed by DSA. The lesion length ranged from 1.3 to 25.6 cm. The patients with steno- sis in the iliae arteries （19）, femoral arteries （31）, below-knee arteries （15） were divided into PTA group （20）, stent group （20） and perfusion group （16）. Procedural success rate was 100%. No severe complications were ob- served. The ankle-brachial index increased from 0.40±0.16 pre-operatively to 0.69±0.15 at the seventh day after treatment. Conclusion Interventional treatment is safe and reliable in patients with diabetic feet. The approach should be modified according to the location of the vascular stenosis.