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[目的]探讨糖尿病足下肢动脉闭塞病变的治疗经验。[方法]总结2004年4月~2009年3月共收治糖尿病足56例患者的下肢动脉闭塞病变的治疗体会,对腹主动脉以下狭窄严重伴足部溃疡的患者肢体进行血管搭桥手术。[结果]2例患者在搭桥后1周和1月人工血管血栓形成,通过取栓后血流恢复,1例术后3月人工血管血栓形成,膝下血管闭塞,自体大隐静脉不能使用,膝下肢体缺血坏疽,取栓术后再次血栓形成,最后导致截肢;1例在半年后流出道腘动脉闭塞行人工血管自体大隐静脉动脉化,术后2年肢体良好,但死于膀胱癌。另外一例取栓后未再有血栓形成,但至今足部溃疡仍未痊愈;其他患者在血管搭桥后都取得了较好的效果,在搭桥后下肢血流明显改善,足部溃疡愈合速度加快。3例患者死亡,分别是由于呼吸循环衰竭1例和消化道大出血2例。[结论]加强糖尿病足下肢动脉闭塞病变术前评估、选择合适的外科治疗和围手术期管理可明显降低截肢率,提高患者生活质量。
[Objective] To investigate the treatment of diabetic lower extremity arterial occlusive disease. [Methods] From April 2004 to March 2009 a total of 56 cases of diabetic foot treatment of lower extremity arterial occlusive disease treatment experience, the abdominal aortic stenosis with foot ulcers in patients with limb bypass surgery. [Results] Two patients had thrombosis of artificial blood vessels at 1 week and 1 month after bypass, blood flow recovery after thrombolysis, 1 case of artificial blood vessel thrombosis in 3 months after operation, occlusion of knee vessels, failure of autologous saphenous vein, Limb ischemia and gangrene, thrombosis after thrombolysis, and finally lead to amputation; one case after six months outflow tract 腘 artery occlusion artificial saphenous vein arterialization of autologous saphenous vein after 2 years of good limbs, but died of bladder cancer. In the other case, there was no further thrombosis after thrombectomy. However, foot ulcers were still not healed up till now. Other patients achieved good results after vascular bypass. The blood flow of the lower extremities was significantly improved and the healing of foot ulcers accelerated. Three patients died, one case of respiratory failure and two cases of gastrointestinal bleeding. [Conclusion] To strengthen preoperative assessment of diabetic foot lower extremity arterial occlusive disease, select appropriate surgical treatment and perioperative management can significantly reduce the amputation rate and improve the quality of life of patients.