摘要
目的 评价血管区域（Angiosome）概念在下肢重症缺血（critical limb ischemia,CLI）腔内治疗中的临床价值.方法 回顾性分析2011年7月至2013年10月在Angiosome概念指导下行膝下动脉血管成形术的62例（62侧肢体）CLI（Rutherford 5级/6级）患者的临床资料.根据是否开通缺血血管区域源血管分为直接组35例（开通缺血血管区域源血管）和间接组27例（开通相邻血管）,对2组患者的踝-肱指数（ankle-brachial index,ABI）、溃疡愈合情况及无截肢率等临床疗效指标进行对比分析.结果 2组患者术前ABI（直接组0.16 ±0.26,间接组0.15 ±0.28,P=0.885）和术后ABI（直接组0.82 ±0.26,间接组0.81 ±0.24,P=0.877）差异无统计学意义;术后1年间的溃疡愈合率直接组（91％）明显高于间接组（74％）,差异有统计学意义（P =0.027）,2组患者的溃疡愈合时间直接组（162 ±49）d,间接组（160 ±46）d,差异无统计学意义（P=0.950）;1年无截肢率直接组（84％±3％）明显高于间接组（76％±4％）,差异有统计学意义（P=0.025）,2年无截肢率直接组（79％±4％）明显高于间接组（72％±4％）,差异有统计学意义（P=0.031）. 结论 应用Angiosome 概念指导腔内治疗有助于提高CLI患者的临床疗效,促进溃疡创面愈合和提高无截肢率.
Objective To evaluate the clinical value of endovascular therapy based on Angiosome concept in critical limb ischemia （CLI） patients.Methods A retrospective study was undertaken in 62 patients （62 limbs） diagnosed as critical limb ischemia （Rutherford class 5/6） and received percutaneous transluminal angioplasty from July 2011 to October 2013.Patients were divided into direct （35 patients） and indirect （27 patients） groups depending on whether feeding artery flow to the site of ulcer was successfully achieved or not based on the angiosome concept,and the between-group clinic outcomes including preoperative and postoperative ankle-brachial index （ABI）,ulcer healing,and the rates of freedom from amputation were compared and analyzed.Results There were no significant difference between two groups for ABI pre-operatively （0.16 ±0.26 vs.0.15 ±0.28; P =0.885） and post-operatively （0.82 ± 0.26 vs.0.81 ±0.24; P =0.877）.During follow-up,the healing rate of ischemia ulcer in patients without amputation at 1 year （91％ vs.74％ ; P =0.027） were significantly higher in the direct group than in the indirect group.There was no difference between two groups for healing time （162 ±49） d vs.（160 ±46） d; P =0.950）.The rates of freedom from amputation at 1 year （84％ ±3％ vs.76％ ±4％ ; P =0.025） and 2 years （79％ ±4％ vs.72％ ±4％ ; P =0.031） were significantly higher in the direct group than in the indirect group.Conclusions Endovascular therapy based on Angiosome concept in CLI patient is an effective procedure with satisfactory clinic outcomes,contributing to healing of ischemia ulcer and increase amputation-free rate.
出处
《中华普通外科杂志》
CSCD
北大核心
2014年第8期571-575,共5页
Chinese Journal of General Surgery
基金
国家自然科学基金面上基金资助项目（81370441）
上海市自然科学基金青年基金资助项目（12ZR1454100）
长海医院学科建设科研创新探索基金资助项目（CH125543100）
