下肢动脉球囊成形术治疗糖尿病足的临床研究

Clinical research of lower limb artery balloon angioplasty on treatment of diabetic foot

目的评价小腿动脉球囊导管成形术治疗耱尿病足的疗效和安全性。方法将糖尿病足患者随机分为两组,治疗组与对照组各48例,治疗组采用高顺应性小球囊导管进行扩张成形,对伴有股动脉病变同时行扩张成形或投放支架。术后给予前列地尔及甲钴胺注射液治疗3周;口服血栓通胶囊、拜阿司匹林及波立维治疗1年,对照组仅给予上述药物治疗。结果治疗组中38例血管再通,1年内无再闭塞。4例血管再通后1年内再闭塞,2例第2次介入治疗后再通。6例血管未通。因足坏疽导致截肢7例截肢平面在小腿中下段1/3处4例,3例仅截去病变的足趾。8例手术未成功或者再闭塞者,1例溃疡愈合,其余均截肢。本组溃疡愈合的时间为(25±6)d;对照组:仅有25例血流恢复,23例缺血症状无改善。26例溃疡愈合;22例溃疡未愈合而截肢,13例截肢平面在小腿中上段1/3处。4例在小腿中下段1/3处,5例截肢平面在大腿中上段1/3处。本组溃疡愈合的时间为(48±8)d。两组比较,治疗组血管再通率为83%,对照组为52%,差异有统计学意义(P<0.01)。而总的截肢率治疗组为29%,对照组为46%,差异有统计学意义(P<0.01)。治疗组的截肢平面较对照组的低,差异有统计学意义(P<0.01)。治疗组溃疡愈合率及愈合时间优于对照组,差异有统计学意义(P<0.01)。结论下肢动脉球囊导管成形术治疗糖尿病足,下肢血管的再通率高,截肢率低,保肢率高。同时,它可以缩短溃疡的愈合时间,降低截肢平面。

Objective To evaluate the safety and effect of lower llmb artery balloon angioplasty on treatment of diabetic foot. Methods The patients with diabetic foot were randomly divided into two groups,with 48 cases in each group.The patients in the treatment group were treated with a high compliance small balloon catheter expansion forming,and the patients with the femoral artery disease were treated with expansion or put on the bracket forming.The alprostadil and mecobalamin injection were performed for 3 weeks after operation;and Xueshuantong capsule,aspirin and clopidogrel were performed for 1 year.The control group only received the same drug treatment. Results Treatment group：38 cases with vascular recanalization had no occlusion within 1 year after the operation,and g cases had occlusion within 1 year,2 of them got recanalization in second interventional treatment.6 cases of operation were not successful.Lower limb amputations were performed in 7 cases of reeanalization patients for foot gangrene,4 of which were underwent above-the-ankle amputation,and the rest were underwent toe amputations.A total of 8 cases were still suffered from occlusion,one of which experienced ulcer healing,the rest were amputated.The ulcer healing time of this group was（25 ± 6） D.Control group：Only 25 cases had recanalization,the rest had no improvement.26 cases had ulcer healing.22 cases had amputation,13 cases of which had lower limb amputation on the upper portion and 4 cases on the lower portion,5 cases of which had above knee amputation.The ulcer healing time was（48± 8） D.Comparing the two groups,the recanalization rate of the treatment group（83%）was significantly higher than that of the control group（52%） （P 〈 0.01）,while the amputation rate of the treatment group（29%）was significantly lower than that of the control group（46%）（P 〈 0.01）.Amputation level in treatment group was lower than in the control group（P 〈 0.01）.The ulcer healing rate and time of treatment group was better than that in the control group（P 〈 0.01）. Conclusion The higher vascular recanalization rate,lower limb amputation rate and higher rate of limb retention will be obtained by lower limb artery balloon angioplasty for the treatment of diabetic foot,Meanwhile,it can reduce the ulcer healing time and decline the amputation level.