介入治疗糖尿病足近期疗效观察

Observation of short-term effect for interventional therapy of diabetic foot

目的探讨采用球囊经皮腔内血管成形术(PTA)介入治疗糖尿病足的近期临床效果。方法对2013年12月至2014年至3月收治确诊的2型糖尿病合并糖尿病足40例患者的临床资料进行回顾性分析,根据治疗方法的不同分为介入组20例和保守组20例,均以膝下段动脉病变为主。两组均采用饮食控制、胰岛素强化治疗和抗血小板、扩血管、活血等常规治疗。介入组在此基础上采用加长球囊行膝下动脉球囊扩张术。比较两组治疗后1周症状改善及多普勒超声踝肱指数(ABI)的变化。结果治疗后随访1周,介入组技术成功率90.0%(18/20),术后间歇性跛行距离增加发生率高于保守组(80.0%vs 40.0%,P<0.01);患肢麻木减轻或消失、皮温上升、疼痛缓解等症状改善发生率分别为65.0%、85.0%和85.0%,较保守组有所提高,但差异无统计学意义(P>0.05)。患肢ABI比较,介入组由术前的0.48±0.16升至术后的0.87±0.14(P<0.01),对照组由术前的0.49±0.19稍许上升为术后的0.50±0.11(P>0.05),介入组术后明显高于保守组治疗后(P<0.01)。介入组未发生术中、术后并发症。结论介入治疗糖尿病足创伤小、并发症少,近期疗效确切。

Objective To observe the short-term clinical therapeutic effect of balloon percutaneous transluminal angioplasty（ PTA） for the treatment of diabetic foot. Methods Retrospective analysis was performed on the clinical data of40 patients,who were confirmed as having type 2 diabetes mellitus with diabetic foot and mainly had lesions of infrapopliteal artery between December 2013 and March 2014. The 40 patients were divided into intervention group（ 20 cases） and conservative treatment group（ 20 cases） according to the therapy methods. The conventional treatments including diet control,insulin intensive therapy,vasodilator and activating blood were all used in two groups. On top of conventional therapy,the extended balloon dilatation for infrapopliteal artery was applied in intervention group,and the technical success（ having direct blood reached foot originating from at least one artery of the three reconstructed main infrapopliteal arteries）rate was observed. The distance of intermittent claudication,the improvement of symptoms and the change of the anklebrachial index（ ABI） acquired by Doppler ultrasound were compared one week after treatment between two groups. Results The followed up period was one week. The technical success rate in intervention group was 90. 0%（ 18 /20）. The increasing rate of intermittent claudication distance after operation was higher in intervention group than that in conservative treatment group（ 80. 0% vs 40. 0%,P 〈0. 01）. The incidences of symptom improving including alleviation or disappearance of numbness,skin temperature rise and remission of pain in the sick limbs were slightly higher in intervention group（ 65. 0%,85. 0%,85. 0%） than those in conservative treatment group（ 50. 0%,60%,50%）,but the differences had no statistical significance（ all P 〈0. 05）. Compared with pre-operation,the ABI of sick limbs after operation increased significantly in intervention group（ 0. 49 ± 0. 19 vs 0. 87 ± 0. 14,P 〈0. 01） and increased somewhat in conservative treatment group（ 0. 49 ± 0. 19 vs 0. 50 ± 0. 11,P 〈0. 05）,and the post-operation ABI significantly increased in intervention group compared with conservative treatment group（ P 〈0. 01）. No in-and post-operative complications occurred in intervention group. Conclusions Intervention therapy is a safe and effective method for treating diabetic foot,and its shortterm therapeutic effect is definite.