摘要
目的总结重症缺血性糖尿病足感染创面的一站式治疗经验。方法回顾性分析2015年6月至2016年4月收治的15例重症缺血性糖尿病足坏疽患者(15条患肢)临床资料。对所有患者采用腔内修复术(EVR)开通闭塞段血管、手术清创及创面封闭负压引流(NPWT)、抗菌保湿伤口敷料进行一站式序贯治疗,评价感染创面愈合率及患肢保肢率。结果 15例患者中下肢动脉造影显示下肢多节段病变13例,单纯小腿病变2例;泛大西洋学会联盟(TASC)Ⅱ分级D级小腿动脉病变13条,C级病变2条。EVR术后,14条患肢至少开通1支小腿流出道;足底动脉环路(PPL)呈完整弓6例,半弓7例,无弓2例;清创后应用带自制冲洗设备NPWT,创面感染控制时间为(7.85±2.84)d。出院后每3~4日随访,并以抗菌保湿的磺胺嘧啶银脂质水胶伤口敷料换药,结果显示创面愈合12例,平均愈合时间(3.70±0.87)个月,3例未愈合,其中2例小腿截肢(13.3%,足部均为PPL无弓),1例死于心血管事件;创面愈合组PPL病变情况与未愈合组比较,差异有显著统计学意义(P=0.006 7)。结论重症缺血性糖尿病足感染治疗较复杂。EVR、带自制冲洗设备NPWT及抗菌保湿创面敷料一站式联合治疗,可作为首选方法有效增加患肢血供,缩短感染控制时间,降低截肢率。
Objective To summarize clinical experience of one-station therapy for infected seriously-ischemic diabetic foot. Methods The clinical data of 15 patients （15 diseased limbs in total） with infected seriously-ischemic diabetic foot, who were admitted to authors＇ hospital during the period from June 2015 to April 2016 to receive treatment, were retrospectively analyzed. For all patients, one-station sequential therapy was carried out, which included endovascular revascularization （EVR） to open occluded vessel, surgical debridement and closed negative pressure wound drainage and antiseptic moisturizing wound dressing. The healing rate of infected wound and the limb salvage rate were evaluated. Results The 15 patients included 10 males and 5 females, with a median age of 77 years old. Lower extremity angiography showed that multiple segmental lesions of lower limb were detected in 13 patients and simple leg lesions in 2 patients. According to TASC Ⅱ update classification, leg artery disease of grade D was observed in 13 patients and artery disease of grade C in 2 patients. After EVR therapy, at least one branch of leg arteries was reopened in 14 limbs. Intact arterial arch of pedal-plantar loop （PPL） was seen in 6 patients, semi-arterial arch in 7 patients, and absent of arterial arch in 2 patients. After surgical debridement, the wound was washed by using negative pressure wound therapy （NPWT） device as well as self-made washing equipment. The time to control wound infection was （7.85±2.84） days. After discharge, the patients were followed up every 3-4 days, at the same time wound dressing exchange with antibacterial moisturizing sulfadiazine silver lipid hydrogel was conducted. Wound healing was achieved in 12 patients, and the mean healing time was （3.70±0.87） months. The wound failed to heal in 3 patients, among them below knee amputation had to be performed in 2 patients（13.3% , both patients showed absent of arterial arch of PPL）, and the remaining one patient died of cardiovascular event. Statistically significant difference in PPL pathological changes existed between wound healing group and wound un-healing group （P=0.006 7）. Conclusion The treatment of infected seriously- isehemie diabetic foot is rather complicated. Being one-station therapy, the sequential managements, which include EVR, NPWT device together with washing equipment and use of antibacterial moisturizing wound dressing, can effectively increase the blood supply to the affected limb, shorten the time to control infection and lower amputation rate. Therefore, one-station therapy should be regarded as the preferred method for infected seriously-ischemic diabetic foot.
作者
陈佳佺
谢辉
倪其泓
阚科佳
叶猛
张岚
郭相江
CHEN Jiaquan XIE Hui NI Qihong KAN Kejia YE Meng ZHANG Lan GUO Xiangjiang.(Department of Vascular Surgery, Affiliated Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China)
出处
《介入放射学杂志》
CSCD
北大核心
2017年第7期647-650,共4页
Journal of Interventional Radiology
关键词
重症缺血
糖尿病足
感染
一站式治疗
serious ischemia
diabetic foot
infection
one-station therapy
