准分子激光消蚀治疗糖尿病足膝下动脉病变效果分析  

Early outcomes of excimer laser atherectomy for below-the-knee lesions in patients with diabetic foot

作　　者：周思远 蒋小浪 鞠帅[1] 李小燕[1] 陈斌 蒋俊豪 郭大乔 徐欣 董智慧 符伟国 Zhou Siyuan;Jiang Xiaolang;Ju Shuai;Li Xiaoyan;Chen Bin;Jiang Junhao;Guo Daqiao;Xu Xin;Dong Zhihui;Fu Weiguo(Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University,Zhongshan Multidisciplinary Center and Jinshan Operation Center for Diabetic Foot,Shanghai 200540,China;Department of Vascular Surgery,Zhongshan Hospital of Fudan University,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属金山医院血管和创面中心,中山糖尿病足多学科诊疗中心及金山运行中心,上海200540 [2]复旦大学附属中山医院血管外科,国家放射与治疗临床医学研究中心,上海200032

出　　处：《中华外科杂志》2022年第6期599-605,共7页Chinese Journal of Surgery

基　　金：上海市优秀学术带头人项目(19XD1401200);上海市科委“科技创新行动计划”医学创新研究专项(21Y11911800);2021复旦大学上海医学院“临床名医培育工程”。

摘　　要：目的探讨准分子激光消蚀技术治疗糖尿病足伴膝下动脉病变的临床效果。方法回顾性分析2019年9月至2021年5月在复旦大学附属中山医院和复旦大学附属金山医院接受准分子激光消蚀术治疗的11例糖尿病足伴膝下动脉病变患者的临床资料。男性10例,女性1例,平均年龄70.5岁(范围:41~83岁)。共12条患肢,20处血管病变,19处慢性完全闭塞病变,卢瑟福分级均为5级,12条患肢均合并溃疡。记录患者术中情况、术中并发症、术后恢复情况和踝肱指数等。结果患者均顺利完成手术,未发生远端栓塞、限流夹层、穿孔、补救性支架植入等。患者平均随访8.2个月(范围:3~13个月),踝肱指数由术前的0.58(范围:0.24~1.57)升至术后即刻的0.88(范围:0.68~1.05)。术后3个月随访时,1条患肢(1/12)因再狭窄行腔内治疗,5条患肢(5/12)溃疡愈合,无截肢(趾)、死亡、失访患者。术后6个月随访时,2例患者失访,2例患者死亡,6条患肢(6/8)溃疡愈合,1条患肢(1/8)于术后6个月因足趾溃疡长期不愈合行截趾术。结论采用准分子激光消蚀术治疗糖尿病足伴膝下动脉病变可行、有效,为糖尿病足膝下动脉减容提供了新的选择。Objective To evaluate the clinical outcomes of excimer laser atherectomy(ELA)in the treatment of diabetic foot with below-the-knee(BTK)lesions.Methods The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI)after operation were record.Results All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57)before operation to 0.88(range:0.68 to 1.05)after operation.At 3 months after the operation,1 limb(1/12)underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation(limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb(1/8)underwent toe amputation due to prolonged healing of ulcers of toe.Conclusion ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

关 键 词：糖尿病足 激光 准分子 膝下动脉病变 腔内减容 

分 类 号：R658.3[医药卫生—外科学]