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中华介入放射学电子杂志 ›› 2022, Vol. 10 ›› Issue (03) : 245 -249. doi: 10.3877/cma.j.issn.2095-5782.2022.03.005

血管介入

腔内血管成形术治疗糖尿病足部溃疡
张静1, 李绍钦2, 顾晓诚2, 韩云芳3, 叶新华4, 余海洋2, 王健1,(), 贾中芝4,()   
  1. 1. 213004 江苏常州,常州市第二人民医院导管室
    2. 213004 江苏常州,常州市第二人民医院介入血管科
    3. 213004 江苏常州,常州市第二人民医院创面修复专科
    4. 213004 江苏常州,常州市第二人民医院内分泌科
  • 收稿日期:2021-10-28 出版日期:2022-08-25
  • 通信作者: 王健, 贾中芝
  • 基金资助:
    江苏省中医药科技发展计划面上项目(MS2021056); 常州市卫生健康委重大科技项目(ZD201912)

Percutaneous transluminal angioplasty in the treatment of diabetic foot ulcer

Jing Zhang1, Shaoqin Li2, Xiaocheng Gu2, Yunfang Han3, Xinhua Ye4, Haiyang Yu2, Jian Wang1,(), Zhongzhi Jia4,()   

  1. 1. Department of Interventional Catheter Room, Changzhou No. 2 People's Hospital, Jiangsu Changzhou 213004, China
    2. Department of Interventional and Vascular Surgery, Changzhou No. 2 People's Hospital, Jiangsu Changzhou 213004, China
    3. Department of Wound Repair and Regeneration, Changzhou No. 2 People's Hospital, Jiangsu Changzhou 213004, China
    4. Department of Endocrinology, Changzhou No. 2 People's Hospital, Jiangsu Changzhou 213004, China
  • Received:2021-10-28 Published:2022-08-25
  • Corresponding author: Jian Wang, Zhongzhi Jia
引用本文:

张静, 李绍钦, 顾晓诚, 韩云芳, 叶新华, 余海洋, 王健, 贾中芝. 腔内血管成形术治疗糖尿病足部溃疡[J/OL]. 中华介入放射学电子杂志, 2022, 10(03): 245-249.

Jing Zhang, Shaoqin Li, Xiaocheng Gu, Yunfang Han, Xinhua Ye, Haiyang Yu, Jian Wang, Zhongzhi Jia. Percutaneous transluminal angioplasty in the treatment of diabetic foot ulcer[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(03): 245-249.

目的

探讨腔内血管成形术(PTA)治疗糖尿病足溃疡(DFU)的疗效。

方法

回顾性分析2016年1月—2020年1月,在我院接受PTA治疗的39例DFU患者的临床资料,该组患者均同时接受重组牛碱性成纤维细胞生长因子(rb-bFGF)治疗,分析PTA手术成功率,术后1周视觉模拟评分(VAS评分)和踝肱指数(ABI)变化、不良反应及15 d和30 d的溃疡创面收缩率。

结果

39例患者均存在患肢膝下动脉及其靶动脉的严重狭窄及节段性闭塞,对靶动脉进行PTA治疗,35例患者接受了单纯PTA治疗,4例合并股动脉狭窄的患者接受了PTA联合支架植入治疗。PTA成功率为92.3%(36/39例),36例患者Angiographosome体系的术终可见缺血区的血管染色阳性,3例患者PTA失败,未能有效开通靶动脉,Angiographosome体系的术终可见缺血区的血管染色阴性。有3例患者出现穿刺部位皮下血肿,未予特殊处理,逐渐消退。PTA术后1周VAS评分由术前的(8.8 ± 0.7)分下降至(5.3 ± 0.5)分(P < 0.05),患肢ABI从术前的0.37 ± 0.08上升至0.42 ± 0.09(P < 0.05)。39例患者均进行了随访,36例进行PTA成功的患者在术后15 d和30 d时溃疡创面收缩率均明显高于PTA失败的患者(35.5% vs 5.1%和84.7% vs 6.4%),差异均具有统计学意义(P < 0.01)。

结论

PTA治疗DFU安全有效,可以为DFU患者提供一种可选的治疗方式。

Objective

To investigate the efficacy of percutaneous transluminal angioplasty (PTA) in the treatment of diabetic foot ulcer (DFU).

Methods

The clinical data of 39 patients with DFU underwent PTA in our hospital between January 2016 and January 2020 were retrospectively analyzed.All patients were received recombinant bovine basic fibroblast growth factor (rb-bFGF). The success rate of PTA, visual analogue scale (VAS) score and ankle-brachial index (ABI) changes at 1 week after operation, adverse reactions, and ulcer wound shrinkage rate at 15 and 30 days after operation were analyzed.

Results

A total of 39 patients (23 males and 16 females, with an average age of 76.5 ± 5.8 years) were included in this study. Among the 39 patients, 35 patients were treated with PTA alone, and 4 patients were treated with PTA plus stent placement. The success rate of PTA was 92.3% (36/39), 36 patients showed positive blood vessel staining on the angiographosome, and 3 patients failed PTA with the negative blood vessel staining on the angiographosome. Subcutaneous hematomas were occurred in 3 patients and needn't treatment. The pain score of the affected limb was decreased from 8.8 ± 0.7 to 5.3 ± 0.5 (P < 0.05) one week after PTA. The ankle brachial index of the affected limb was increased from 0.37 ± 0.08 to 0.42 ± 0.09 (P < 0.05) one week after PTA. The contraction rates of the ulcer at 15 and 30 days after PTA were 35.5% and 84.7% of patients with PTA successful and were 5.1% and 6.4% of patients who failed PTA (all P < 0.01), respectively.

Conclusions

PTA is an effective method in the management of DFU.

表1 39例患者的基本情况
表2 术后1周患者VAS评分及患肢ABI变化(±s
图1 83岁男性患者,因DFU 15 d就诊1A:患者首次清创换药处理的创面,该患者3 d后进行PTA治疗;1B:PTA术后2 d清创换药处理的创面;1C:PTA术后15 d清创换药处理的创面;1D:PTA术后40 d,溃疡创面痊愈。
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