糖尿病膝下动脉病变腔内治疗的中远期疗效  

Mid and long term results of endovascular procedures for diabetic below-the-knee lesions

作　　者：张童[1] 庄百溪[1] 石波 杨淼[1] 于春利[1] 马鲁波[1] 

机构地区：[1]中国中医科学院西苑医院血管外科,北京100091

出　　处：《中华普通外科杂志》2014年第8期576-579,共4页Chinese Journal of General Surgery

摘　　要：目的 总结分析糖尿病膝下动脉病变患者经腔内治疗的中远期疗效.方法 回顾性分析2005年8月至2012年5月期间连续收治的Wagner 1 ～4级糖尿病膝下动脉病变患者762例（797条患肢）的临床资料,统计经血管腔内治疗的技术成功率、并发症率,随访期间观察踝肱比变化、伤口愈合率、保肢率及生存率.结果 762例（797条患肢）共进行857次血管腔内治疗,即刻技术成功805次（93.93％）.围手术期并发症：入路相关性血肿或假性动脉瘤33例（4.33％）;迷走神经反射20例（2.62％）;膝下动脉破裂38例（4.99％）;血流限制性夹层75例（9.84％）;动脉栓塞23例（3.02％）;蓝趾征4例（0.52％）.术后平均ABI明显改善[（0.33 ±0.20）升至（0.68±0.17）,P＜0.005）].共722例患者（751条患肢）随访12个月以上,平均（35±23）个月,期间3个月内伤口愈合率达72.28％,12个月保肢率为85.62％,生存率为95.01％.结论 腔内治疗糖尿病膝下动脉病变即刻技术成功率高、并发症低,中远期疗效确切,目前可作为其首选治疗方案.Objective To analyze the mid and long term results of endovascular procedures for diabetic below-the-knee lesions.Methods We retrospectively analyzed data of 762 patients （797 limbs in Wagner Grade 1 to 4） who suffered ischemic symptoms of diabetic below-the-knee lesions,admitted for endovascular procedures from Aug 2005 to May 2012.Technical success rate and complications,anklebrachial index,wound healing,limb salvage and survival were evaluated.Results 762 patients （797 limbs） underwent 857 endovascular procedures with immediate technical success in 805 times （success rate 93.93％）.30 day complications included 33 cases （4.33％） of hematoma or pseudoaneurysm related to access site,20 cases （2.62％） of vasovagal reflex,38 cases （4.99％） of belowthe-knee arteriorrhexis,75 cases （9.84％） of inflow-limited dissection,23 cases （3.02％） of arterial embolism,4 cases （0.52％） of blue-toe sign.Postoperative mean ABI was improved significantly,from 0.33 ± 0.20 to 0.68 ± 0.17,P ＜ 0.005.722 patients （751 limbs） were followed up for more than 12 months （35 ± 23 months）,wound healing rate within 3 months was 72.28％,limb salvage rate after 12 months was 85.62％,survival rate was 95.01％.Conclusions Immediate technical success rate of endovascular procedures for diabetic below-the-knee lesions is high,complications rate is low,medium and long term efficacy is satisfactory.

关 键 词：糖尿病血管病变 血管成形术 缺血 四肢救助 存活率 

分 类 号：R587.2[医药卫生—内分泌]