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目的探讨糖尿病足(DF)不同病变部位和性质选择不同介入治疗方法的疗效分析。方法糖尿病足患者52例(65肢),先行DSA测定病变范围及程度,按病变部位狭窄段分为髂动脉、股动脉及膝下动脉,按病变程度分为狭窄性病变及闭塞性病变。根据不同类别采用经皮腔内血管球囊成形术(PTA组)、球囊成形联合内支架植入术(支架组)及经股动脉局部药物灌注术(灌注组)治疗,观察患者术中及术后并发症、技术成功率及临床疗效。结果经造影证实65侧下肢动脉均存在动脉狭窄/闭塞性病变,病变范围1.3～25.6 cm。病变部位在髂动脉、股动脉、膝以下动脉分别19、31、15个肢体。根据狭窄程度及部位分别采用FTA术、球囊成形+支架植入术、局部药物灌注(20、29、16个肢体),技术成功率100%,没有明显并发症出现。术后7天踝肱指数(ABI)由术前的(0.40±0.16)上升至(0.69±0.15)。结论采用微创介入治疗DF具有安全、可靠等特点。根据DF不同类型和血管病变部位采用相应的介入治疗方式是保证疗效的关键。
Objective To investigate the curative effects of different interventional modalities on different parts and properties of diabetic foot (DF). Methods Fifty-two patients (65 limbs) with diabetic foot were enrolled in this study. The extent and degree of lesion were determined by DSA. The iliac artery, femoral artery and inferior arteries were divided into two groups according to the degree of lesion: stenosis and occlusive disease. Percutaneous transluminal angioplasty (PTA group), balloon angioplasty combined with stent-graft (stent group), and local drug perfusion (perfusion group) via femoral artery were performed according to different categories. The intraoperative and / Postoperative complications, technical success rate and clinical efficacy. Results The 65 arteries of the lower extremity arteries were confirmed by contrast-enhanced angiography. Arterial stenosis / occlusive disease ranged from 1.3 to 25.6 cm. Lesions in the iliac artery, femoral artery, knee below the artery 19, 31, 15 limbs. According to the degree of stenosis and the site of FTA, balloon-shaped stent implantation, local drug infusion (20,29,16 limbs), the technical success rate of 100%, no obvious complications. The ankle brachial index (ABI) increased from (0.40 ± 0.16) to (0.69 ± 0.15) before surgery 7 days after operation. Conclusion The minimal invasive treatment of DF is safe and reliable. According to different types of DF and vascular lesions using the appropriate interventional treatment is the key to ensuring efficacy.