• 四川大學(xué)華西醫(yī)院普外二科（成都610041）;

目的　介紹糖尿病合并下肢血管病變的發(fā)病機(jī)理及治療進(jìn)展。 方法　復(fù)習(xí)近幾年的相關(guān)文獻(xiàn)，進(jìn)行綜述。 結(jié)果　糖尿病為周圍動(dòng)脈病變的主要危險(xiǎn)因素之一，糖尿病血管病變包括大血管病變和微血管病變兩種,動(dòng)脈硬化和微循環(huán)的血流減少是下肢缺血的重要因素。下肢的缺血性病變是糖尿病的常見并發(fā)癥，內(nèi)科治療及外科治療均可改善其癥狀。結(jié)論　外科治療是治療糖尿病合并下肢血管病變的有效方法。

引用本文： 劉仁貴,趙紀(jì)春. 糖尿病并發(fā)下肢血管病變的發(fā)病機(jī)理及治療進(jìn)展. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(6): 676-679. doi: 復(fù)制

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2. 　粟　立. 糖尿病性下肢缺血的血管外科治療 [J]. 首都醫(yī)藥， 1999； 6(5)∶44.
3. 　Walters DP, Gatling W, Mullee MA, et al. The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community [J]. Diabet Med, 1992; 9(8)∶710.
4. 　LoGerfo FW, Coffman JD. Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care [J]. N Engl J Med, 1984; 311(25)∶1615.
5. 　Stonebridge PA, Murie JA. Infrainguinal revascularization in the diabetic patient [J]. Br J Surg, 1993; 80(10)∶1237.
6. 　張培華主編. 臨床血管外科學(xué) [M]. 北京: 科學(xué)出版社, 2003∶2212~2215.
7. 　張自杰. 糖尿病性神經(jīng)病 [J]. 中華顯微外科雜志， 1993; 16(3)∶230.
8. 　劉　麗， 靖冬梅, 王愛林. 血管內(nèi)超聲消融術(shù)治療糖尿病足的療效觀察 [J]. 中華糖尿病雜志， 2004; 12(5)∶332.
9. 　Akbari CM, Macsata R, Smith BM, et al. Overview of the diabetic foot [J]. Semin Vasc Surg, 2003; 16(1)∶3.
10. 　許樟榮. 糖尿病足病變研究進(jìn)展 [J]. 中國醫(yī)師雜志， 2004； 6（1）∶1.
11. 　Arora S, Pomposelli F, LoGerfo FW, et al. Cutaneous microcirculation in the neuropathic diabetic foot improves significantly but not completely after successful lower extremity revascularization [J]. J Vasc Surg, 2002; 35(3)∶501.
12. 　Boulton AJ. Pressure and the diabetic foot: clinical science and offloading techniques [J]. Am J Surg, 2004; 187(5A)∶17S.
13. 　曹永吉， 李衛(wèi)東. 2型糖尿病下肢血管病變形態(tài)學(xué)特點(diǎn)研究 [J]. 實(shí)用心腦肺血管病雜志， 2004； 12（2）∶107.
14. 　Lavery LA, Baranoski S, Ayello EA. Options for off-loading the diabetic foot [J]. Adv Skin Wound Care, 2004; 17(4 Pt 1)∶181.
15. 　Neder S, Nadash P. Individualized education can improve foot care for patients with diabetes [J]. Home Healthc Nurse, 2003; 21(12)∶837.
16. 　高　杰, 李天宇， 李令根. 糖尿病足治療進(jìn)展 [J]. 黑龍江中醫(yī)藥， 2003； 12(6)∶56.
17. 　廉德勝. 糖尿病足的藥物治療 [J]. 中華現(xiàn)代臨床醫(yī)學(xué)雜志， 2003； 9(6)∶508.
18. 　鄭子恢. 安步樂克 [J]. 中國新藥雜志, 1999; 8(11)∶772.
19. 　Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure [J]. Ann Plast Surg, 2004; 53(6)∶517.
20. 　Calhoun JH, Overgaard KA, Stevens CM, et al. Diabetic foot ulcers and infections: current concepts [J]. Adv Skin Wound Care, 2002; 15(1)∶31.
21. 　Fowler EM, Vesely N, Johnson V, et al. Wound care for persons with diabetes [J]. Home Healthc Nurse, 2003; 21(8)∶531.
22. 　鄧福生， 胡何節(jié)， 王曉天， 等. 糖尿病足的外科治療 [J]. 中國臨床保健雜志， 2004; 7(2)∶96.
23. 　谷涌泉， 齊立行. 糖尿病性下肢缺血病變的外科治療 [J]. 中國現(xiàn)代手術(shù)學(xué)雜志， 2003; 7(2)∶101.
24. 　Bommayya I, Edmonds M. The importance of infra-inguinal angioplasty in salvage of diabetic foot [C]. Neurodiab and DFSC of EASD Joint Meeting. Hungary, 2002∶130.
25. 　Karacagil S, Almgren B, Bowald S, et al. Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing infrainguinal bypass surgery [J]. Diabet Med, 1995; 12(6)∶537.
26. 　Kunlin J, Lengua F, Kunlin A, et al. New experimental documents on circulatory reversal by arteriovenous fistula in ischemia of the extremities [J]. J Mal Vasc, 1983; 8(4)∶287.
27. 　王體沛. 糖尿病足的外科治療 [J]. 內(nèi)科急重癥雜志， 2002； 8(1)∶39.
28. 　楊曉鳳, 吳雁翔, 王紅梅. 自體外周血干細(xì)胞移植治療糖尿病足26例臨床研究 [J]. 中國實(shí)用內(nèi)科雜志， 2004； 11(11)∶676.
29. 　Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes [A]. In: Harris MI, Cowie CC, Stern MP, et al. eds. Diabetes in America [M]. 2nd ed. Washington DC: US Government Printing Office, 1995∶409-428.
  1. 1. 　Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? [J]. Diabetes Metab Res Rev, 2000; 16 Suppl 1∶S75.
  2. 2. 　粟　立. 糖尿病性下肢缺血的血管外科治療 [J]. 首都醫(yī)藥， 1999； 6(5)∶44.
  3. 3. 　Walters DP, Gatling W, Mullee MA, et al. The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community [J]. Diabet Med, 1992; 9(8)∶710.
  4. 4. 　LoGerfo FW, Coffman JD. Current concepts. Vascular and microvascular disease of the foot in diabetes. Implications for foot care [J]. N Engl J Med, 1984; 311(25)∶1615.
  5. 5. 　Stonebridge PA, Murie JA. Infrainguinal revascularization in the diabetic patient [J]. Br J Surg, 1993; 80(10)∶1237.
  6. 6. 　張培華主編. 臨床血管外科學(xué) [M]. 北京: 科學(xué)出版社, 2003∶2212~2215.
  7. 7. 　張自杰. 糖尿病性神經(jīng)病 [J]. 中華顯微外科雜志， 1993; 16(3)∶230.
  8. 8. 　劉　麗， 靖冬梅, 王愛林. 血管內(nèi)超聲消融術(shù)治療糖尿病足的療效觀察 [J]. 中華糖尿病雜志， 2004; 12(5)∶332.
  9. 9. 　Akbari CM, Macsata R, Smith BM, et al. Overview of the diabetic foot [J]. Semin Vasc Surg, 2003; 16(1)∶3.
  10. 10. 　許樟榮. 糖尿病足病變研究進(jìn)展 [J]. 中國醫(yī)師雜志， 2004； 6（1）∶1.
  11. 11. 　Arora S, Pomposelli F, LoGerfo FW, et al. Cutaneous microcirculation in the neuropathic diabetic foot improves significantly but not completely after successful lower extremity revascularization [J]. J Vasc Surg, 2002; 35(3)∶501.
  12. 12. 　Boulton AJ. Pressure and the diabetic foot: clinical science and offloading techniques [J]. Am J Surg, 2004; 187(5A)∶17S.
  13. 13. 　曹永吉， 李衛(wèi)東. 2型糖尿病下肢血管病變形態(tài)學(xué)特點(diǎn)研究 [J]. 實(shí)用心腦肺血管病雜志， 2004； 12（2）∶107.
  14. 14. 　Lavery LA, Baranoski S, Ayello EA. Options for off-loading the diabetic foot [J]. Adv Skin Wound Care, 2004; 17(4 Pt 1)∶181.
  15. 15. 　Neder S, Nadash P. Individualized education can improve foot care for patients with diabetes [J]. Home Healthc Nurse, 2003; 21(12)∶837.
  16. 16. 　高　杰, 李天宇， 李令根. 糖尿病足治療進(jìn)展 [J]. 黑龍江中醫(yī)藥， 2003； 12(6)∶56.
  17. 17. 　廉德勝. 糖尿病足的藥物治療 [J]. 中華現(xiàn)代臨床醫(yī)學(xué)雜志， 2003； 9(6)∶508.
  18. 18. 　鄭子恢. 安步樂克 [J]. 中國新藥雜志, 1999; 8(11)∶772.
  19. 19. 　Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure [J]. Ann Plast Surg, 2004; 53(6)∶517.
  20. 20. 　Calhoun JH, Overgaard KA, Stevens CM, et al. Diabetic foot ulcers and infections: current concepts [J]. Adv Skin Wound Care, 2002; 15(1)∶31.
  21. 21. 　Fowler EM, Vesely N, Johnson V, et al. Wound care for persons with diabetes [J]. Home Healthc Nurse, 2003; 21(8)∶531.
  22. 22. 　鄧福生， 胡何節(jié)， 王曉天， 等. 糖尿病足的外科治療 [J]. 中國臨床保健雜志， 2004; 7(2)∶96.
  23. 23. 　谷涌泉， 齊立行. 糖尿病性下肢缺血病變的外科治療 [J]. 中國現(xiàn)代手術(shù)學(xué)雜志， 2003; 7(2)∶101.
  24. 24. 　Bommayya I, Edmonds M. The importance of infra-inguinal angioplasty in salvage of diabetic foot [C]. Neurodiab and DFSC of EASD Joint Meeting. Hungary, 2002∶130.
  25. 25. 　Karacagil S, Almgren B, Bowald S, et al. Comparative analysis of patency, limb salvage and survival in diabetic and non-diabetic patients undergoing infrainguinal bypass surgery [J]. Diabet Med, 1995; 12(6)∶537.
  26. 26. 　Kunlin J, Lengua F, Kunlin A, et al. New experimental documents on circulatory reversal by arteriovenous fistula in ischemia of the extremities [J]. J Mal Vasc, 1983; 8(4)∶287.
  27. 27. 　王體沛. 糖尿病足的外科治療 [J]. 內(nèi)科急重癥雜志， 2002； 8(1)∶39.
  28. 28. 　楊曉鳳, 吳雁翔, 王紅梅. 自體外周血干細(xì)胞移植治療糖尿病足26例臨床研究 [J]. 中國實(shí)用內(nèi)科雜志， 2004； 11(11)∶676.
  29. 29. 　Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes [A]. In: Harris MI, Cowie CC, Stern MP, et al. eds. Diabetes in America [M]. 2nd ed. Washington DC: US Government Printing Office, 1995∶409-428.