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-  2017 

特定皮肤区域血供研究应用于中国人群下肢重症缺血腔内治疗价值的回顾分析 Retrospective Evaluation of the Angiosome Concept for Endovascular Therapy in Patients with Critical Limb Ischemia

Keywords: 特定皮肤区域血供,膝下动脉腔内成形术,下肢重症缺血,保肢率

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Abstract:

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

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