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目的评价糖尿病对血管重建(腔内及手术)治疗慢性重症下肢缺血的影响。方法回顾性分析3年间北京朝阳医院因慢性重症下肢缺血行下肢血管重建治疗的121例患者(130条肢体)的临床资料。其中,糖尿病组(DM组)55例(60条肢体),行动脉转流手术27条肢体,单纯经皮动脉球囊扩张(PTA)9条肢体,PTA+支架20条肢体,转流手术+腔内治疗杂交手术4条肢体;非糖尿病组(NDM组)66例(70条肢体),行动脉转流手术28条肢体,单纯PTA 10条肢体,PTA+支架24条肢体,转流手术+腔内治疗杂交8条肢体。随访3~36个月,比较两组患者的围手术期病死率、术后1年生存率及保肢率。结果围手术期病死率DM组为9.1%,NDM组为6.1%,两组差异无统计学意义(P>0.05);术后1年生存率DM组为88.1%,NDM组为93.1%,两组差异亦无统计学意义(P>0.05);术后1年保肢率DM组为81.6%,NDM组为83.4%,两组差异亦无统计学意义(P>0.05)。结论对于因慢性重症下肢缺血行下肢血管重建的患者,糖尿病并不增加其围手术期病死率,也不降低其远期生存率及保肢率。笔者认为,对于糖尿病慢性重症下肢缺血患者应积极进行血管重建治疗。
Objective To evaluate the effect of diabetes on the treatment of chronic severe lower limb ischemia with revascularization (endovascular and surgical). Methods The clinical data of 121 patients (130 limbs) undergoing lower extremity revascularization for chronic severe lower limb ischemia in Beijing Chaoyang Hospital during 3 years were retrospectively analyzed. Among them, 55 cases (60 limbs) in diabetic group (DM group), 27 limbs underwent arterial bypass operation, 9 limbs with PTA alone, 20 limbs with PTA + stent, 66 cases (70 limbs) in non-diabetic group (NDM group), 28 limbs undergoing arterial bypass surgery, 10 simple PTA limbs, 24 limbs of PTA + stent, Treatment of hybrid 8 limbs. The patients were followed up for 3 to 36 months. Perioperative mortality, 1-year survival rate and limb salvage rate were compared between the two groups. Results Perioperative mortality was 9.1% in DM group and 6.1% in NDM group, with no significant difference between the two groups (P> 0.05). The 1-year survival rate was 88.1% in DM group and 93.1% in NDM group There was no significant difference between the two groups (P> 0.05). One year after operation, the limb salvage rate was 81.6% in the DM group and 83.4% in the NDM group, with no significant difference between the two groups (P> 0.05). Conclusions Diabetes does not increase perioperative mortality, nor does it reduce its long-term survival rate and limb salvage rate in patients undergoing lower extremity vascular revascularization due to chronic severe lower extremity ischemia. In my opinion, for patients with chronic severe chronic leg ischemia should be actively revascularization.