糖尿病与非糖尿病患者下肢动脉旁路移植术后移植血管闭塞原因分析  

Analysis of arterial graft occlusion of the lower limbs in diabetics and non-diabetics

作　　者：谷涌泉[1] 张建[1] 齐立行[1] 俞恒锡[1] 李建新[1] 李学锋[1] 郭连瑞[1] 崔世军[1] 罗涛[1] 陈兵[1] 吴英锋[1] 齐一侠[1] 佟铸[1] 汪忠镐[1] 

机构地区：[1]首都医科大学宣武医院血管外科 首都医科大学血管外科研究所,北京100053

出　　处：《中华普通外科杂志》2008年第2期140-142,共3页Chinese Journal of General Surgery

基　　金：首都医学发展基金资助项目（2002-1013）

摘　　要：目的探讨下肢动脉旁路移植术后血管闭塞的原因。方法回顾性分析2002年1月至2006年4月收治的49例下肢动脉旁路移植后移植血管闭塞患者的临床资料。49例患者中，糖尿病下肢缺血者23例，占46．9％；非糖尿病下肢缺血26例，占53．1％。结果在术后13～24个月移植的血管容易闭塞，本组占36．8％（18／49）；其次是6个月以内的血管也容易闭塞，占26．5％（13／49）；而在6～12个月和25～48个月期间进入一个比较平稳的阶段。糖尿病组与非糖尿病组移植血管闭塞时间比较，差异无统计学意义（P〉0．05）。在吻合口内膜增生导致的血管闭塞原因和在使用抗凝药方面，糖尿病组和非糖尿病组比较，差异无统计学意义（P〉0．05）；在移植血管近、远段动脉病变方面，糖尿病组与非糖尿病组相比，差异有统计学意义（P〈0．05）。结论下肢动脉旁路移植后血管闭塞除了内膜增生外，动脉硬化进一步发展，使移植血管近段或远段闭塞也是导致移植血管闭塞的重要原因，尤其是糖尿病患者更容易发生。Objective To explore causes of graft occlusion after lower limb arterial bypass. Method Forty-nine patients with graft occlusion after lower limb arterial bypass from January 2002 to April 2006 were retrospectively analysed. Of the patients, 23/49 （46. 9% ） were of diabetic lower limb ischemia and 26/49 （53. 1% ） were of non-diabetic lower limb ischemia. Results Grafts occlusion developed in 36. 8% （18/49） cases from 13rd to 24th month after graft bypass, 26. 5% （13/49） grafts became occluded within the first 6 months intervened by two comparatively stable period from respectively 7th to 12nd month and 25th to 48th month. The time when graft becomes occlusive does not vary significantly between diabetic and non-diabetic patients （ P 〉 0.05 ）. There were no significant statistical differences （ P 〉 0. 05 ） in intima hyperplasia in the anastomosis area between diabetic and non-diabetics. However, there were significant statistical differences （P 〈 0. 05） in proximal or / and distal arteriopathy of the grafts between diabetic and non-diabetic. Conclusions With the exception of infima hyperplasia in the anastomosis area, the most important cause of graft occlusion was proximal or / and distal arteriopathy, especially for diabetic patients.

关 键 词：缺血 血管外科手术 动脉旁路移植 移植闭塞 血管 腿 

分 类 号：R686[医药卫生—骨科学]