糖尿病对血管重建治疗慢性重症下肢缺血的影响  

Impact of diabetes mellitus on results of revascularization for chronic critical lower limb ischemia

作　　者：廖传军[1] 姜涛[2] 杨宝钟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院血管外科,北京100020 [2]吉林油田总医院普外二科,吉林松原138000

出　　处：《中国普通外科杂志》2011年第6期575-578,共4页China Journal of General Surgery

摘　　要：目的评价糖尿病对血管重建（腔内及手术）治疗慢性重症下肢缺血的影响。方法回顾性分析3年间北京朝阳医院因慢性重症下肢缺血行下肢血管重建治疗的121例患者（130条肢体）的临床资料。其中,糖尿病组（DM组）55例（60条肢体）,行动脉转流手术27条肢体,单纯经皮动脉球囊扩张（PTA）9条肢体,PTA＋支架20条肢体,转流手术＋腔内治疗杂交手术4条肢体;非糖尿病组（NDM组）66例（70条肢体）,行动脉转流手术28条肢体,单纯PTA 10条肢体,PTA＋支架24条肢体,转流手术＋腔内治疗杂交8条肢体。随访3~36个月,比较两组患者的围手术期病死率、术后1年生存率及保肢率。结果围手术期病死率DM组为9.1%,NDM组为6.1%,两组差异无统计学意义（P〉0.05）;术后1年生存率DM组为88.1%,NDM组为93.1%,两组差异亦无统计学意义（P〉0.05）;术后1年保肢率DM组为81.6%,NDM组为83.4%,两组差异亦无统计学意义（P〉0.05）。结论对于因慢性重症下肢缺血行下肢血管重建的患者,糖尿病并不增加其围手术期病死率,也不降低其远期生存率及保肢率。笔者认为,对于糖尿病慢性重症下肢缺血患者应积极进行血管重建治疗。Objective To investigate the influence of diabetes mellitus（DM） on revascularization（endovascular therapy and open surgery） for chronic critical lower limb ischemia（CLI）.Methods The clinical data of 121 patients（130 affected limbs） undergoing revascularization for CLI in Chaoyang hospital within 3 years were retrospectively analyzed.Of the patients,55 cases（60 affected limbs） with DM（DM group） were treated as follows： Twenty-seven limbs underwent artery shunting surgery,9 limbs underwent percutaneous transluminal angioplasty（PTA）,20 limbs underwent PTA plus stent implantation and 4 limbs underwent artery shunting surgery combined with endovascular therapy.Sixty-six cases（70 affected limbs） of non-diabetic（NDM） patients（NDM group） were treated as follows： Twenty-eight limbs underwent artery shunting surgery,10 limbs underwent PTA,24 limbs underwent PTA plus stent implantation and 8 limbs underwent artery shunting surgery combined with endovascular therapy.All patients were followed up from 3 to 36 months,and the perioperative mortality,1-year cumulative survival or limb salvage rate between the two groups were compared.Results Perioperative mortality in DM group and NDM group was 9.1% and 6.1%,respectively（P0.05）;1-year cumulative survival rate in DM group and NDM group was 88.1% and 93.1%,respectively（P0.05）;Limb salvage rate in DM group and NDM group was 81.6% and 83.4%,respectively（P0.05）.Conclusions DM has no influence on revascularization for CLI in respect to perioperative mortality,1-year cumulative survival and limb salvage rate.Thus,these results suggest that revascularization shoud be aggressively perfomed in CLI patient with DM.

关 键 词：糖尿病 重度下肢缺血 血管重建 腔内治疗 

分 类 号：R654.4[医药卫生—外科学]