CAJ | 학술논문

目的总结糖尿病足患者腔内治疗后动脉再闭塞的原因及治疗方法.方法回顾性分析天津市第一中心医院2009年1月1日至2013年10月1日收治的371例糖尿病足腔内治疗后动脉再闭塞患者的病因、治疗方法等临床资料.结果首次腔内治疗时按照泛大西洋协作组织(Trans-Alantic Inter-Society Consensus,TASC)Ⅱ分级:A级37例、B级85例、C级143例、D级106例.再次闭塞时间为1d至36个月,平均(21±8)个月.再闭塞的原因:内膜增生263例(70.9％)、血栓形成65例(17.5％)、夹层形成19例(5.1％)、支架断裂17例(4.6％)、血管破裂7例(1.9％).再闭塞后给予再次腔内治疗327例(88.1％),动脉旁路手术23例(6.2％),保守治疗13例(3.5％),直接截肢(截趾)4例(1.1％),围手术期死亡4例(1.1％).共随访275例患者,随访时间1～ 36个月,平均(13±8)个月.6、12、24个月的血管通畅率分别为82.9％、71.3％、63.0％,截肢率分别为1.1％、1.8％、2.5％.结论内膜增生是造成糖尿病足腔内治疗后动脉再闭塞的主要原因.多数患者可再次腔内治疗,近期通畅率较高.
목적 총결당뇨병족환자강내치료후동맥재폐새적원인급치료방법.방법 회고성분석천진시제일중심의원2009년1월1일지2013년10월1일수치적371례당뇨병족강내치료후동맥재폐새환자적병인、치료방법등림상자료.결과 수차강내치료시안조범대서양협작조직(Trans-Alantic Inter-Society Consensus,TASC)Ⅱ분급:A급37례、B급85례、C급143례、D급106례.재차폐새시간위1d지36개월,평균(21±8)개월.재폐새적원인:내막증생263례(70.9％)、혈전형성65례(17.5％)、협층형성19례(5.1％)、지가단렬17례(4.6％)、혈관파렬7례(1.9％).재폐새후급여재차강내치료327례(88.1％),동맥방로수술23례(6.2％),보수치료13례(3.5％),직접절지(절지)4례(1.1％),위수술기사망4례(1.1％).공수방275례환자,수방시간1～ 36개월,평균(13±8)개월.6、12、24개월적혈관통창솔분별위82.9％、71.3％、63.0％,절지솔분별위1.1％、1.8％、2.5％.결론 내막증생시조성당뇨병족강내치료후동맥재폐새적주요원인.다수환자가재차강내치료,근기통창솔교고.
Objective To investigate the causes of arterial reocclusion in diabetic feet patients after endovascular treatment and its remedial measures.Methods From January 2009 to October 2013,clinical data of 371 arterial reocclusion of diabetic feet patients after endovascular treatment in Tianjin First Central Hospital were reviewed retrospectively.We summarized the causes of reocclusion,treatment methods and the short term results.Results According to the Trans-Alantic Inter-Society Consensus (TASC) Ⅱ grading standards,the first time when the endovascular treatment started there were 37 cases of grade A,85 cases of grade B,143 cases of grade C,106 cases of grade D.Arterial re-occlusion developed from one day to 36 months,averaging at (21 ± 8) months.Causes of re-occlusion included intimal hyperplasia in 263 cases (70.9％),thrombosis in 65 cases (17.5％),dissection in 19 cases (5.1％),stent fracture in 17 cases (4.6％),vascular rupture in 7 cases (1.9％).Remedial therapy adopted for arterial reocclusion was repeated endovascular treatment in 327 cases (88.1％),arterial bypass surgery in 23 cases (6.2％),conservative treatment in 13 cases (3.5％),amputation (cut toe) in 4 cases (1.1％),4 cases (1.1％) died perioperatively.275 cases were followed up for 1 to 36 months,the average was (13 ± 8) months.patency rate was 82.9％,71.3％ and 63.0％ at 6 months,1 year and 2 years.Amputation rate was 1.1％,1.8％ and 2.5％ at 6 months,1 year and 2 years.Conclusions Intimal hyperplasia is to blame for arterial reocclusion after endovascular treatment of diabetic foot.In this case most patients still can benefit from second time endovascular treatment,with a satisfactory short term patency rate.