Angiosome理念在糖尿病足及下肢重度肢体缺血中的应用  

Clinical application of angiosome concept for the treatment of diabetic foot and critical limb ischemia

作　　者：李先涛[1] 郭平凡[1] 庄晖[1] 蔡方刚[1] 张金池[1] 刘学强[1] 戴贻权[1] 吴捷[1] 詹腾辉[1] 何天敏[1] 

机构地区：[1]福建医科大学附属第一医院血管外科,福州350005

出　　处：《中华普通外科杂志》2014年第2期123-126,共4页Chinese Journal of General Surgery

摘　　要：目的 探讨angiosome理念在糖尿病足（diabetic foot,DF）和下肢重度肢体缺血（critical limb ischemia,CLI）的临床应用及治疗策略.方法 回顾性分析2010年1月至2011年6月收治的糖尿病足（FontaineⅣ期）患者42例（48条肢体）和CLI（FontaineⅣ期）患者40例（42条肢体）,分为DF组和CLI组,2组患者均按angiosome理念打通下肢病变血管,随访6个月,比较2组患者的血管病变特点及治疗效果.结果 2组患者受累血管的分布差异有统计学意义（x2 =15.115,P=0.004）,CLI组中受累的股浅动脉（x2=7.981,P=0.005）及胭动脉（x2=5.026,P=0.025）显著多于DF组；2组患者技术成功率（DF组75％,CLI组76.19％,P=0.896）、临床成功率（DF组70.83％,CLI组83.33％,P=0.162）、大截肢率（DF组8.33％,CLI组7.14％,P=0.833）、死亡率（DF组7.14％,CLI组5.00％,P=0.523）差异均无统计学意义.结论 糖尿病足和CLI下肢受累血管的分布明显不同,但临床治疗效果基本相同.以angiosome理念为基础的腔内治疗能改善糖尿病足和CLI治疗的临床成功率,尚需要更多的前瞻性随机对照试验来支持angiosome理念的临床应用.Objective To assess application and clinical results of angiosome concept in treating diabetic foot and critical lower extremity ischemia.Methods A retrospective study was made on 82 consecutive patients （42 patients with diabetic feet,40 patients with CLI） who underwent infrainguinal angioplasty or angioplasty combined with stenting guided by angiosome concept from 2010.01 to 2011.06.After 6-month follow-up was completed,the documented data including preoperative and postoperative ABI value,location of foot ulcers,distribution of culprit infrainguinal vessels,technical and clinical results were analyzed and compared using SPSS 17.0.Results There was no difference of demographical features between these two groups.Improved ABI value in DF group and CLI group were 0.20 ＆#177;0.16,0.39 ＆#177;0.11 at 6 months,respectively,P 〈 0.001.Locations of feet ulcers did not differ between two groups （P =0.706）,whilst the distribution of culprit vessels was different statistically （P =0.004）,with higher rate of involved superficial femoral arteries and popliteal arteries in CLI group（P =0.005） than in DF group（P =0.005）.The technical success rate （75% in DF group,76.19% in CLI group,P =0.896）,clinical success rate（70.83% in DF group,83.33% in CLI group,P =0.162）,major amputation rate（8.33% in DF group,7.14% in CLI group,P =0.833）and mortality（7.14% in DF group,5.00% in CLI group,P =0.523） were not significantly different in these two groups.Conclusions There is significant difference in distribution of lower extremity culprit vessels between patients of diabetic foot and CLI,with similar technical and clinical results.The endovascular therapy guided by angiosome concept may prove beneficial in terms of better wound healing and subsequent limb salvage.

关 键 词：糖尿病足 临床方案 足溃疡 腔内治疗 

分 类 号：R654.4[医药卫生—外科学]