Inderbitzi R, Büttiker M, Pfluger D, Nachbur B
Department of Thoracic and Cardiovascular Surgery, University of Bern, Inselspital, Switzerland.
Eur J Vasc Surg. 1992 May;6(3):321-6. doi: 10.1016/s0950-821x(05)80327-5.
Sixty-six patients with end-stage peripheral vascular disease who had undergone bilateral major amputation of the lower extremities in our institution during the 10-year period January 1980-December 1989 were reviewed. There were 46 males and 20 females with an age range from 34 to 91 years (mean 67.7 years). A 98.5% follow-up was achieved. Of these patients 25% underwent their second amputation in the first, 50% within the second and 75% within the third postoperative year, notwithstanding the fact that prior attempts at revascularisation had been performed in 62% of all patients. The 30-day hospital mortality was 4.5%. The initial level of amputation was metatarsal in 14.4%, below knee in 66.6%, through knee in 9.9% and above knee in 9.1%. Out of a total of 132 stumps 89 healed by primary intention. Following secondary revisions and amputations the final level of amputation was metatarsal in 7%, below knee in 49%, through knee in 14% and above knee in 30%. Survival rates were 62% after 2 years, 31% after 5 years, and 14% after 8 years. By this time all diabetics had died, while 33% of non-diabetics were still alive (p greater than 0.02). Age, sex and amputation level had no bearing upon survival rate. Forty-three patients (65.1%) were ambulatory after their first amputation, but following contralateral amputation barely more than half (23 patients) were able to walk. In the presence of bilateral stage IV disease it is highly important to rehabilitate the patient immediately following unilateral amputation before considering amputation of the contralateral limb, otherwise the patient will not become ambulatory.
回顾了1980年1月至1989年12月期间在我院接受双侧下肢大截肢手术的66例终末期周围血管疾病患者。其中男性46例，女性20例，年龄范围为34至91岁（平均67.7岁）。随访率为98.5%。尽管62%的患者此前曾尝试进行血管重建，但这些患者中25%在术后第一年进行了第二次截肢，50%在第二年进行了第二次截肢，75%在第三年进行了第二次截肢。30天住院死亡率为4.5%。初次截肢水平为跖骨的占14.4%，膝下截肢的占66.6%，经膝关节截肢的占9.9%，膝上截肢的占9.1%。在总共132个残肢中，89个一期愈合。经过二次修复和截肢后，最终截肢水平为跖骨的占7%，膝下截肢的占49%，经膝关节截肢的占14%，膝上截肢的占30%。2年后生存率为62%，5年后为31%，8年后为14%。此时所有糖尿病患者均已死亡，而非糖尿病患者仍有33%存活（p>0.02）。年龄、性别和截肢水平与生存率无关。43例患者（65.1%）在首次截肢后能够行走，但对侧截肢后能够行走的患者仅略多于一半（23例）。对于双侧IV期疾病患者，在考虑对侧肢体截肢之前，单侧截肢后立即对患者进行康复治疗非常重要，否则患者将无法行走。
