经皮腔内血管成形术治疗糖尿病患者下肢动脉病变  

Percutaneous Transluminal Angioplasty for the Treatment of Diabetic Patients with Lower Extremity Ischemia

作　　者：田然[1] 谭正力[1] 郁正亚[1] 

机构地区：[1]首都医科大学附属北京同仁医院血管外科,北京100730

出　　处：《中国微创外科杂志》2013年第9期785-788,795,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：首都医学发展科研基金资助<糖尿病下肢缺血外科治疗多中心随机对照和临床注册研究>;项目编号:2009-2001Clinical Trial No.:NCT01171703

摘　　要：目的评价经皮腔内血管成形术治疗糖尿病患者下肢缺血的疗效。方法回顾分析我科2008年5月～2012年3月经皮腔内血管成形术治疗2型糖尿病下肢缺血89例的l临床资料，记录其内科情况、股胭动脉TASC（泛大西洋协作组）Ⅱ分级、流出道评分、Rutherford分期以及术后30天并发症。随访计算一期通畅率（Kaplan—Meier）、分级情况、保肢率，观察其疗效。结果共89例108条患肢。年龄（70．5±8．6）岁。术前踝肱指数（ABI）中位数0．36（0～0．73），术后1个月0．79（0．33～1．15，Z=-3．276，P=0．001）。术前胫腓动脉流出道评分中位数7．5分（3．5～10分），术后即刻中位数6．0分（1．5～9分，Z=-2．948，P=0．003）。股胭及膝下胫腓动脉腔内血管成形术技术成功率分别为97．2％（105／108）和93．3％（98／105）。随访患者86例105条患肢。中位随访时间13个月（5～46个月），随访期间死亡3例，均死于急性心肌梗死，随访率90．7％（78／86）。术后1年股胭动脉一期通畅率67．3％，胫腓动脉为56．3％，1年保肢率91．9％（34／37），1年时症状缓解率83．3％（90／108）。结论经皮腔内血管成形术治疗糖尿病合并下肢动脉闭塞性病变症状缓解明显，有较高的保肢率，可以作为糖尿病合并下肢动脉闭塞性病变．特别是膝下病变治疗的首选．远期疗效有待讲一步观察．Objective To evaluate the effect of pereutaneous transluminal angioplasty （PTA） for the treatment of diabetic patients with lower extremity isehemia. Methods A retrospective analysis was conducted on the data of 89 patients with type 2 diabetes mellitus （108 limbs） undergoing PTA between May 2008 and March 2012. Demographic characteristics, comorbidity and complications within 30 days postoperatively were recorded. Patients were classified according to Rutherford classification. Society for Vascular Surgery （SVS） runoff scores were determined after the completion of the intervention, and the primary patency, limb salvage, and target vessels pateney were assessed by Kaplan-Meier life-table analysis. Results There were 108 limbs undergoing PTA in 89 patients （mean age, 70.5 ＋ 8.6 years）. The median ankle-braehial index （ABI） improved from 0.36 （0 -0, 73） preoperatively to 0.79 （0.33 - 1.15, Z = - 3. 276, P = 0. 001 ） 1 month postoperatively. The median score of runoff improved from 7.5 （3.5 - 10） preoperatively to 6.0 （ 1. 5 - 9, Z = - 2. 948, P = 0. 003） immediately after the surgery. Technical success rate was 97. 2% （105/108） in femoral-popliteral artery and 93.3% （98/105） in infra-popliteral artery respectively. Eighty six patients were followed up for 5 months to 46 months （median, 13 months）. The follow-up rate was 90.7% （78/86）. Three patients died of acute myocardial infarction during follow-up. The limb salvage rate within 1 year was 91.9% （34/37）. The 1 year primary pateney was 67.3% in femoral-popliteral artery and 56.3% in infra-popliteral artery respectively. The remission rate was 83.3% （90/108）. Conclusions PTA has higher limb salvage rate and higher remission rate in patients with diabetes. PTA can be considered as an initial option for the treatment of infra-popliteal artery stenosis or occlusion of patients with type 2 diabetes mellitus, Further research is needed to evaluate long-term outcome.

关 键 词：动脉粥样硬化 2型糖尿病 腔内成形术 

分 类 号：R654.3[医药卫生—外科学]