糖尿病下肢动脉阻塞性病变介入治疗疗效分析  

Interventional therapy for arterial occlusive disease of lower extremity in patients with diabetes:an analysis of therapeutic results

作　　者：肖亮[1] 申景[1] 黄德生[2] 童家杰[1] 张曦彤[1] 徐克[1] 

机构地区：[1]沈阳中国医科大学附属第一医院放射科,110001 [2]沈阳中国医科大学附属第一医院基础医学院数学教研室,110001

出　　处：《介入放射学杂志》2011年第3期218-223,共6页Journal of Interventional Radiology

基　　金：国家十一五科技支撑计划(2007BAI05B04)

摘　　要：目的评估糖尿病合并周围动脉阻塞性病变(PAOD)介入治疗的可行性及疗效;方法回顾性分析2006年至2009年期间为治疗糖尿病伴发跛行患者及下肢严重缺血患者而进行的63次介入治疗。治疗手段包括:单纯PTA及PTA加支架置入。介入治疗的病变血管共85支,包括髂动脉15支(17.6%)、股动脉36支(42.4%)、腘动脉20支(23.5%)、胫动脉14支(16.5%)。采用Kaplan-Meier曲线法确定通畅率(根据超声复查结果)。平均随访时间为21.9个月(6～36月);结果63例患者中合并高血压37例(占58.7%)、合并冠心病19例(占30.2%)、吸烟史占52.2%。介入操作技术成功率97.8%,术后30 d无死亡病例。ABI值明显升高(由术前0.397±0.136升至术后0.783±0.134;P<0.01)。6、12、24和36个月的初次通畅率分别为84.4%、57.9%、49.8%及40.7%,相应的二次通畅率分别为91.1%、79.1%、65.7%及54.1%(P<0.01)。相应的肢体保存率分别为93.3%、86%、83.3%及83.3%;结论经皮血管再通治疗具有创伤小、并发症及死亡率低的优点,同时还不阻挠必要时外科血管重建手术,深受众多患者的认同并逐渐成为治疗慢性下肢缺血患者的首选方法。Objective To discuss the feasibility and outcomes of interventional therapy for peripheral arterial occlusive disease（PAOD）in patients with diabetes.Methods During the period of 2006-2009 a total of 80 interventional procedures were performed in 63 diabetes patients who suffered from intermittent claudication or severe ischemia of lower limb.Forty-six patients received a single interventional procedure and the other seventeen patients received the treatment two times.The clinical data,including complications and outcomes,were retrospectively analyzed.The therapeutic means included PTA alone and PTA together with arterial stenting.The treated arteries included iliac（17.6%）,femoral（42.4%）,popliteal（23.5%）and tibial artery（16.5%）.Based on the ultrasonographic re-examination findings the arterial patent rate was determined with Kaplan-Meier method.The mean follow-up time was 21.9 months（ranged from 6 to 36 months）.Results The mean age was 71.4 years and 57.3% were males.Hypertension was accompanied in 37 patients（58.7%）,and coronary artery disease in 19 patients（30.4%）.In 52.2% of patients there was a history of cigarette smoking.The technical success rate of interventional procedure was 97.8%（45/46）.No death occurred within 30 days after the treatment.Ankle brachial index was increased from 0.397 ± 0.136 before operation to 0.783 ± 0.134 after operation,with P 〈0.001.The initial arterial patency at 6,12,24 and 36 months was 84.4%,57.9%,49.8% and 40.7% respectively,while the corresponding secondary arterial patency was 91.1%,79.1%,65.7% and 54.1% respectively（P 〈0.01）.At 6,12,24 and 36 months,the limb-salvage rate was 93.3%,86%,83.3% and 83.3% in patients with limb-threatening conditions.Conclusion Percutaneous interventional revascularization management is a micro-invasive treatment for peripheral arterial occlusive disease in diabetes patients.This techniaue carries low risk of morbidity and mortality and fewer complications.Also,the procedure will not interfere with th

关 键 词：糖尿病 动脉阻塞性病变 介入治疗 效果 

分 类 号：R587.2[医药卫生—内分泌]