摘要
目的:探讨特定皮肤区域血供(Angiosome)研究指导膝下动脉腔内重建术(EVR)治疗下肢重症缺血(CLI)的临床疗效。评估特定皮肤区域血供研究指导膝下动脉EVR术治疗CLI的应用价值。同时分析CLI病人通过EVR治疗开放流出道(RO)数量与保肢率相关性,评价流出道再通数量与病人保肢率的关系。方法:收集2005年2月至2015年5月在我院接受EVR的58名CLI患者(58条患肢)进行回顾性分析。患者分为直接组(DR)与间接组(IR)。术后随访5-12个月,平均随访(11.60±1.40)个月。比较两组病人治疗前后踝肱指数(ABI)、溃疡愈合率、溃疡愈合时间、保肢率以及生存率等指标。结果:本组膝下动脉EVR术58例(58条患肢),围手术期死亡0例,随访死亡率8.62%。(1)ABI:术前术后相比,两组患者ABI增高差异均有统计学意义。两组间ABI增加幅度差异有统计学意义。(2)伤口愈合率:DR组90.3%(28/31)较IR组74.7%(20/27)显著提高(P=0.048),卡普兰-迈耶分析(K-M)Log Rank=1.490,P=0.04,差异有统计学意义。(3)患者术后12月保肢率为81.0%(47/58),DR组87.1%(27/31)较IR组74.1%(20/27)显著提高(P=0.027),K-M分析Log Rank=2.504,P=0.03,差异有统计学意义。(4)术后12月累积生存率:DR组97%(30/31)较IR组85.1%(23/27)显著提高,Log Rank=1.299,P=0.254,差异无统计学意义。(5)随访发现,EVR重建RO数量对应保肢率分别为1条83.3%(30/36)、2条80%(14/18)、3条75%(3/4),P=0.842。EVR术重建RO数量与保肢率无明显相关性。结论:特定皮肤区域血供研究指导膝下动脉腔内成形术,能帮助建立精准有效的下肢血液循环,对改善CLI患者下肢缺血情况,促进缺血损伤组织愈合和提高保肢率有重要意义。
Objective:To evaluate the effect of the angiosome concept on endovascular revascularization(EVR)for patient with critical limb ischemia(CLI).Methods:Fifty-eight limbs in 58 consecutive patients between Feb.2005 and May.2015 with ischemic ulceration(Rutherford 5or 6)who underwent endovascular therapy(EVT)alone without bypass surgery were classified into direct(DR)and indirect(IR)groups.The ABI before and after EVR,healing rate and time of the ulceration/gangrene,freedom from amputation were compared between the direct and the indirectgroups,and 1-year disease free actuarial survival rates was also compared between these two groups by Kaplan-Meier analysis.In addition,the numbers of run-off vessels after EVR and limbs salvage were also compared to value the relationship of these two factors.Results:Fifty-eight cases(58limbs)were received endovascular intervention,the technical success rate was 100%,the perioperation mortality was 0%.Then,58 patients or 58 limbs were followed up for average 11.6±1.40months(5-12months).the mortality was 8.62%in follow-up period,suggesting that the total mortality was also 8.62%.(1)The ABI after EVT:either the direct group or the indirect group recived the rasing of ABI,which in direct group was much higher than in indirect group(P<0.05).(2)Healing rate of the ulceration:the total ulceration healing rate was 82.7%(48/58),which was significantly higher in the direct group as 90.3%(28/31)than in the indirect group as 74.7%(20/27)(P=0.048).(3)The overall 1-year limb salvage after the procedure was81.0%(47/58),which was also higher in direct group(87.1%,27/31)than in indrect group(74.1%,20/27)(P=0.027).(4)There was no statistic difference between the direct group(97%,30/31)and the indirect group(81.4%,24/27)(P=0.545)in free actuarial survival rates after EVT.Interestingly,we found that the number of vessels with run-off flow did not influence the limb salvage rate(P=0.842)in either the direct group(P=0.424)or the indirect group(P=0.943).Conclusion:Acquiring direct flow based on the angiosome concept may be important for ulcer healing and limb salvage by EVT in patients with CLI.
出处
《武汉大学学报（医学版）》
CAS
2017年第3期499-504,共6页
Medical Journal of Wuhan University
