下肢动脉血管再通修复重建对下肢动脉缺血导致创面修复的影响  

Effect of low arterial reconstruction on repair of wound induced by lower limb ischemia

作　　者：王晓军[1] 宋国成[1] 王建宁[1] 张军[1] 高继东[1] 殷岳[1] 

机构地区：[1]北京市第六医院血管外科,100007

出　　处：《中华损伤与修复杂志（电子版）》2007年第3期162-165,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨下肢动脉血管再通修复重建对下肢动脉缺血导致创面修复的影响。方法2003年6月至2007年5月对226例下肢动脉缺血导致创面的患者分为未行下肢动脉血管再通修复重建的患者118例和行下肢动脉血管再通修复重建的患者(包括经皮腔内血管成形修复及支架置入术、人工或自体血管搭桥动脉旁路移植术、动脉血管内膜硬化斑剥脱血管成型修复、动脉血管切开取栓和大网膜移植血流再通重建术)108例共两组,采用超声彩色多普勒和选择性血管造影进行检查是否存在下肢动脉的缺血,分析创面的愈合情况(包括创面愈合时间、截肢率和复发率等)。结果(1)226例下肢动脉缺血形成的创面中足部感染或溃疡197例(87%,197/226),小腿皮肤慢性感染和溃疡29例(13%,29/226)。创面<1 cm者59例(26%,59/226),创面1～2 cm者77例(34%,77/226),创面2～5 cm者63例(28%,63/226),创面>5 cm者27例(12%,27/226);(2)226例行超声彩色多普勒检查阳性结果201例(阳性率89%,201/226),其中完全闭塞者48例(24%,48/201),重度狭窄者71例(35%,71/201),中度狭窄者82例(41%,82/201);(3)行选择性血管造影者192例,检测阳性结果为167例(87%,167/ 192),其中髂总动脉+髂外动脉+股动脉闭塞或狭窄者23例(14%,23/167),髂外动脉+股动脉闭塞或狭窄者39例(23%,39/167),股动脉+腘动脉闭塞或狭窄者58例(35%,58/167),腘动脉下动脉血管闭塞或狭窄者47例(28%,47/167);(4)在108例下肢动脉血管再通修复重建的患者中,经皮腔内血管成形修复再通重建(PTA)及支架置入术32例(30%,32/108),人工或自体血管搭桥动脉旁路移植血管修复再通重建(髂-股动脉、髂-腘动脉、股-股动脉、股-腘动脉、股-胫前或后动脉)术36例(33%,36/108),动脉血管内膜硬化斑剥脱血管成型修复再通重建术25例(23%,25/108),动脉血管切开取栓再通术11例(10%,11/108),大网膜移植血流再通重建术4例(4%,4/108);(5)行和未行下肢动脉血�Objective To explore the effect of Effect of low arterial reconstruction on repair of wound induced by lower limb ischemia. Methods From June 2003 to May 2007, 226 patients with lower limb ischemia induced wound were analysed and evaluted. Among them, 108 patients with lower limb ischemia were treated by lower arterial vascular reconstruction. The patients with lower limb ischemia were exam- ined by digital subtraction angiop＇aphic （DSA） and colour Doppler. The time of wound repair and the rate of recur rence and the rate of amputation of patients with lower limb ischemia were analysed. Results （ 1 ） 197 wounds of patients with lower limb ischemia were occured on foot, and 29 wounds of patients with lower limb ischemia were occured on shank. Among them, the length of 〈 1 cm, 1-2 cm,2-5 cm, 〉 5 cm of wound of patients with lower limb ischemia was 26% （59/226） ,34% （77/226） ,28% （63/226）, 12% （27/226） respectively; （2）The colour Doppler were performed in 226 patients with lower limb ischemia, the positive rate was 89% （201/226）. Among them,the narrow rate of wholeness, criticalness and medium was 24% （48/ 201 ） ,35% （71/201） and 41% （ 82/201 ）, respectively ; （3） The DSA was performed in 192 patients with lower limb ischemia,the positive rate was 87% （167/192）. Among them, the narrow rate of common iliac a. ＋ Ext. iliac a. ＋ femoral a. , Ext. iliac a. ＋ femoral a. , femoral a. ＋ popliteal a. and lower of popliteal a. was 14% （23/167） ,23% （ 39/167 ）, 35% （ 58/167 ） and 28% （47/167）, respectively; （4） The reconstruction of lower arterial vessel was performed in 108 patients with lower limb ischemia. Among them, the percutaneous transluminal angioplasty, graft bypass, endarterectomy, Fogarty catheter embolectomy and graft omentum majus was 30% （32/108） ,33% （36/108）, 23% （25/108）, 10% （11/108） and 4% （4/108）, respectively; （5） The shortened days of wound repair of patients with lower limb ischemia between the

关 键 词：下肢动脉缺血 创面修复 血管再通 经皮腔内血管成形修复 

分 类 号：R654.3[医药卫生—外科学]