糖尿病足下肢动脉闭塞性病变的治疗选择  

OPTIONS IN DIABETIC LOWER LIMB ARTERY OCCLUSION

作　　者：黄斌[1] 赵纪春[1] 马玉奎[1] 冉兴无[2] 卢武胜[1] 吴洲鹏[1] 杨轶[1] 

机构地区：[1]四川大学华西医院肝脏及血管外科,成都610041 [2]四川大学华西医院内分泌科

出　　处：《现代预防医学》2011年第12期2402-2403,2406,共3页Modern Preventive Medicine

摘　　要：[目的]探讨糖尿病足下肢动脉闭塞病变的治疗经验。[方法]总结2004年4月~2009年3月共收治糖尿病足56例患者的下肢动脉闭塞病变的治疗体会,对腹主动脉以下狭窄严重伴足部溃疡的患者肢体进行血管搭桥手术。[结果]2例患者在搭桥后1周和1月人工血管血栓形成,通过取栓后血流恢复,1例术后3月人工血管血栓形成,膝下血管闭塞,自体大隐静脉不能使用,膝下肢体缺血坏疽,取栓术后再次血栓形成,最后导致截肢;1例在半年后流出道腘动脉闭塞行人工血管自体大隐静脉动脉化,术后2年肢体良好,但死于膀胱癌。另外一例取栓后未再有血栓形成,但至今足部溃疡仍未痊愈;其他患者在血管搭桥后都取得了较好的效果,在搭桥后下肢血流明显改善,足部溃疡愈合速度加快。3例患者死亡,分别是由于呼吸循环衰竭1例和消化道大出血2例。[结论]加强糖尿病足下肢动脉闭塞病变术前评估、选择合适的外科治疗和围手术期管理可明显降低截肢率,提高患者生活质量。[Objective]To investigate the effect and experience of treatment on diabetic lower limb arterial occlusion.[Methods]The experience of surgical operation of 56 cases with diabetic foot with lower limb arterial occlusion summarized from April 2004 to March 2009.All cases had severe stenosis below the abdominal aorta and sever ulcer of foot received by-pass operation.[Results]3 cases were complicated with graft thrombosis at 7 days,30 days and 90 days after operation respectively,in which 1 case had a recurrence of thrombosis after thrombectomy,and led to amputation eventually;One case received arterialized operation of great saphenous vein because of popliteal artery was complicated with occlusion,and the limb obtained a good outcome within two years before the case died for bladder carcinoma;The other cases obtained a better outcome,the blood flow was improved apparently,the restitution of the foot ulcer was speeded up.3 cases died,1 was for respiratory and circulatory failure and the other 2 cases were for severe alimentary tract hemorrhage.[Conclusion]Detailed evaluation,optimal surgical modality selection and perioperative management could significantly improve life quality and decrease amputation rate in patients with diabetic lower limb arterial occlusion.

关 键 词：糖尿病足 动脉闭塞 治疗 

分 类 号：R587.1[医药卫生—内分泌]