• 重慶醫(yī)科大學(xué)附屬成都第二臨床學(xué)院 成都市第三人民醫(yī)院（成都，610031）1 內(nèi)分泌科，2 介入治療科，3 骨科，4 彩超室;

【摘要】　目的　 探討2型糖尿病合并下肢血管病變血管內(nèi)介入治療的臨床意義。　方法　 2009年1-5月對(duì)4例2型糖尿病合并下肢血管病變患者，根據(jù)血管狹窄情況選擇不同介入治療方式，行下肢動(dòng)脈造影及動(dòng)脈球囊擴(kuò)張或支架成形術(shù)。　結(jié)果　 4例患者均有表現(xiàn)靜息痛及間歇性跛行，下肢血管超聲顯示糖尿病下肢動(dòng)脈有不同程度的斑塊、狹窄與血栓形成，病變累及下肢股動(dòng)脈、髂動(dòng)脈及脛前、足背動(dòng)脈。介入治療后患者下肢血管灌注得到明顯改善，靜息痛及間歇性跛行明顯改善，皮溫改善，需要截肢患者截肢平面顯著降低。　結(jié)論　 通過下肢血管DSA造影檢查，準(zhǔn)確了解糖尿病患者下肢血管的阻塞部位及程度，在保守治療基礎(chǔ)上選擇不同方式的介入治療，有助于下肢血管病變的明顯改善。
【Abstract】　Objective　 To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities.　Methods　 From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy.　Results　 Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased.　Conclusion　 It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.

引用本文： 李莎,劉西平,鐘曉衛(wèi),周政,梁煒,羅靜,周鴻,付徐泉,劉宜東. 2型糖尿病合并下肢血管病變介入治療探討. 華西醫(yī)學(xué), 2011, 26(1): 15-17. doi: 復(fù)制

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1. 　Winocour PH, Morgan J, Ainsworth A, et al. Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues[J]. Diabet Med, 2002, 19(Suppl 4): 32-38.
2. 　何利平, 冉興無. 糖尿病足診治進(jìn)展[J]. 內(nèi)科急危重癥雜志, 2008, 14(4): 171-173.
3. 　李莎, 呂麗芳, 鐘曉衛(wèi). 糖尿病足相關(guān)風(fēng)險(xiǎn)十年調(diào)查分析[J]. 中國全科醫(yī)學(xué), 2010, 13(8): 2539-2542.
4. 　Faglia E, Mantero M, Caminiti M, et al. Extensive use of peripheral angioplasty, particularly in frapopliteal, in the treatment of ischemic diabetic foot ulcers: clinical result s of a multicentric study of 221 consecutive diabetic subjects[J]. J Intern Med, 2002, 252 (3): 225-232.
5. 　Ha Van G. Management of a diabetic foot ulcer[J]. Rev Med Intern, 2008, 29(2): 238-242.
6. 　Lyden SP. Techniques and outcomes for endovascular treatment in the tibial arteries[J]. J Vasc Surg, 2009, 50(5): 1219-1223.
7. 　Williams R, Van Gaal L, Lucioni C. Assessing the impact of complications on the costs of Type 2 diabetes[J]. Diabetologia, 2002, 45(7): 13-17.
8. 　Dyet JF, Nicholson AA, Ettles DF. Vascular imaging and intervention in peripheral arteries in the diabetic patient[J]. Diabetes Metab Res Rev, 2000, 16(1): 16-22.
9. 　莊百溪．糖尿病周圍血管病變的腔內(nèi)治療[J]. 醫(yī)學(xué)研究雜志, 2006, 35(10): 69-70.
10. 　徐克, 于世平, 蘇洪英, 等. 主-髂-股動(dòng)脈閉塞性病變介入治療的技術(shù)探討及療效觀察[J]. 中華放射學(xué)雜志, 2005, 39(4): 383-387.
11. 　Lawall H, Gorriahn H, Amendt K. Long-term outcomes after medical and interventional therapy of critical limb ischemia[J]. Eur J Intern Med, 2009, 20(6): 616-621.
12. 　趙允, 王富軍. 糖尿病下肢血管病變介入治療進(jìn)展[J]. 臨床薈萃, 2010, 24(24): 2184-2186.
13. 　Peeters P, Keirse K, Verbist J. Other endovascular methods of treating the diabetic foot[J]. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.
  1. 1. 　Winocour PH, Morgan J, Ainsworth A, et al. Association of British Clinical Diabetologists (ABCD): survey of specialist diabetes care services in the UK, 2000. 3. Podiatry services and related foot care issues[J]. Diabet Med, 2002, 19(Suppl 4): 32-38.
  2. 2. 　何利平, 冉興無. 糖尿病足診治進(jìn)展[J]. 內(nèi)科急危重癥雜志, 2008, 14(4): 171-173.
  3. 3. 　李莎, 呂麗芳, 鐘曉衛(wèi). 糖尿病足相關(guān)風(fēng)險(xiǎn)十年調(diào)查分析[J]. 中國全科醫(yī)學(xué), 2010, 13(8): 2539-2542.
  4. 4. 　Faglia E, Mantero M, Caminiti M, et al. Extensive use of peripheral angioplasty, particularly in frapopliteal, in the treatment of ischemic diabetic foot ulcers: clinical result s of a multicentric study of 221 consecutive diabetic subjects[J]. J Intern Med, 2002, 252 (3): 225-232.
  5. 5. 　Ha Van G. Management of a diabetic foot ulcer[J]. Rev Med Intern, 2008, 29(2): 238-242.
  6. 6. 　Lyden SP. Techniques and outcomes for endovascular treatment in the tibial arteries[J]. J Vasc Surg, 2009, 50(5): 1219-1223.
  7. 7. 　Williams R, Van Gaal L, Lucioni C. Assessing the impact of complications on the costs of Type 2 diabetes[J]. Diabetologia, 2002, 45(7): 13-17.
  8. 8. 　Dyet JF, Nicholson AA, Ettles DF. Vascular imaging and intervention in peripheral arteries in the diabetic patient[J]. Diabetes Metab Res Rev, 2000, 16(1): 16-22.
  9. 9. 　莊百溪．糖尿病周圍血管病變的腔內(nèi)治療[J]. 醫(yī)學(xué)研究雜志, 2006, 35(10): 69-70.
  10. 10. 　徐克, 于世平, 蘇洪英, 等. 主-髂-股動(dòng)脈閉塞性病變介入治療的技術(shù)探討及療效觀察[J]. 中華放射學(xué)雜志, 2005, 39(4): 383-387.
  11. 11. 　Lawall H, Gorriahn H, Amendt K. Long-term outcomes after medical and interventional therapy of critical limb ischemia[J]. Eur J Intern Med, 2009, 20(6): 616-621.
  12. 12. 　趙允, 王富軍. 糖尿病下肢血管病變介入治療進(jìn)展[J]. 臨床薈萃, 2010, 24(24): 2184-2186.
  13. 13. 　Peeters P, Keirse K, Verbist J. Other endovascular methods of treating the diabetic foot[J]. J Cardiovasc Surg (Torino), 2009, 50(3): 313-321.