经皮腔内血管成形术在糖尿病足患者外科治疗中的应用  

Application of percutaneous transluminai angioplasty in the surgical treatment of patients with diabetic feet

作　　者：高娅[1] 崔正军[1] 史迅[1] 郭鹏飞[1] 孟庆楠[1] 杨高远 杨荣强[1] 

机构地区：[1]郑州大学第一附属医院烧伤与修复重建外科,450052

出　　处：《中华烧伤杂志》2016年第8期479-483,共5页Chinese Journal of Burns

基　　金：河南省科技厅重大攻关项目（132102310377）

摘　　要：目的探讨经皮腔内血管成形术（PTA）在糖尿病足患者外科治疗中的应用价值。方法回顾性分析2011年9月-2014年9月笔者单位收治的符合人选标准的83例糖尿病足患者临床资料，患足95只，创面95个。按是否行PTA治疗将患者分为未接受PTA治疗的常规治疗组43例（创面51个）和接受PTA治疗的PTA组40例（创面44个）。2组患者入院后均行常规清创，PTA组患者清创术前另行1次PTA治疗。2组患者均由清创后开始，计算治疗第3、6、9、12天创面肉芽生长良好率。统计2组患者Ⅱ期术前创面准备时间。按Wagner分级，统计2组患者创面植皮成活与缝合口愈合情况。统计2组患者随访半年内，每个月复查时的踝肱指数（ABI），以及溃疡复发情况。对数据行∥检验、t检验。结果常规治疗组患者治疗后创面肉芽生长良好率上升趋势较缓慢，治疗第12天创面肉芽生长良好率仍小于40％；PTA组患者创面肉芽生长良好率从治疗第9天起明显上升，治疗第12天全部生长良好。治疗第9、12天，PTA组患者创面肉芽生长良好率明显高于常规治疗组（x^2值分别为30．008、47．810，P值均小于0．01）。常规治疗组患者Ⅱ期术前创面准备时间为（24±10）d，明显长于PTA组的（15±3）d，t=5．709，P〈0．01。PTA组患者植皮成活、缝合口愈合的Wagner2、3、4级创面比例明显高于常规治疗组（，值为6．741～24．498，P值均小于0．01）。PTA组患者出院后随访半年内每个月ABI均明显高于常规治疗组（t值为5．411—9．583，P值均小于0．01）。常规治疗组患者随访4个月内溃疡无复发，随访第5、6个月分别有1、2例复发；PTA组患者随访半年内溃疡无复发。结论PTA在糖尿病足患者外科治疗中效果肯定，有一定临床应用价值。Objective To explore the application of percutaneous transluminal angioplasty （PTA） in the surgical treatment of patients with diabetic feet. Methods The clinical data of 83 patients with diabetic feet, 95 limbs （95 wounds） in total, hospitalized in our unit from September 2011 to September 2014, conforming to the study criteria, were retrospectively analyzed. Patients were divided into conventional treat- ment group （ CT, n =43, 51 wounds） and PTA group （ n =40, 44 wounds） according to whether receiving PTA treatment or not. Patients in two groups received conventional debridement after admission, and patients in PTA group received another PTA treatment before debridement. Granulation growing well rates of wounds of patients in two groups were calculated on post debridement day （PDD） 3, 6, 9, and 12. Two stage pre- operative preparation time of wounds of patients in two groups was recorded. Status of free skin graft survival of wounds and wound healing of patients in two groups were recorded according to the grade of Wagner. Val- ues of ankle-brachial index （ABI） and ulcer recurrence of patients in two groups checked every month during follow-up time of half a year were recorded. Data were processed with ehi-square test and t test. Results Granulation growing well rate of wounds of patients in group CT rose slowly after treatment, which was less than 40% on PDD 12. Granulation growing well rate of wounds of patients in PTA group rose signif- icantly on PDD 9 and all the granulation grew well on PDD 12. On PDD 9 and 12, Granulation growing well rates of wounds of patients in PTA group were significantly higher than those in group CT （withx2 values respectively 30. 008 and 47. 810, P values below 0.01 ）. Two stage preoperative preparation time of wounds of patients in group CT [ （24 ±10） d] was obviously longer than that in PTA group [ （15 ±3） d, t =5.709, P 〈0.011 ） The ratios of survived free skin graft and healed suture in Wagner 2, 3, and 4 wounds of patients in PTA gr

关 键 词：糖尿病足 血管成形术 皮肤移植 伤口愈合 

分 类 号：R587.2[医药卫生—内分泌] R658.3[医药卫生—内科学]