Rosenblatt M S, Quist W C, Sidawy A N, Paniszyn C C, LoGerfo F W
Division of Vascular Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215.
Surg Gynecol Obstet. 1990 Oct;171(4):331-5.
The results of 171 vein grafts of the lower extremity were evaluated. These were placed between January 1981 and December 1987 in 150 patients, 75 diabetic and 75 nondiabetic, to determine the influence of diabetes on the outcome of the procedure. One and four year patency rates were determined by a life table analysis. No statistical differences in primary patency were found between the patients with diabetes and those without diabetes for all indications of operations (one year, diabetic patients 95 +/- 3 per cent, nondiabetic patients 85 +/- 3 per cent; four years, diabetic patients 89 +/- 11 per cent and nondiabetic patients 80 +/- 12 per cent; p = n.s.). For those operated upon for salvage of the limb because of rest pain, ulceration or gangrene, patency in diabetic patients at one year approached a statistically significant advantage (diabetic patients 94 +/- 4 per cent versus nondiabetic patients 79 +/- 8 per cent; p = 0.056). We believe that arterial reconstruction of the lower extremity can be performed upon patients with diabetes with the same high degree of success for revascularization and salvage of the limb as can be accomplished in nondiabetic patients. This is true even though those with diabetes present with necrosis of the tissue and more often require bypass to distal tibial arteries.
对171例下肢静脉移植的结果进行了评估。这些移植手术于1981年1月至1987年12月间在150例患者中进行，其中糖尿病患者75例，非糖尿病患者75例，以确定糖尿病对手术结果的影响。通过寿命表分析确定了1年和4年的通畅率。在所有手术指征方面，糖尿病患者和非糖尿病患者的初次通畅率无统计学差异（1年时，糖尿病患者为95±3%，非糖尿病患者为85±3%；4年时，糖尿病患者为89±11%，非糖尿病患者为80±12%；p = 无显著性差异）。对于因静息痛、溃疡或坏疽而接受肢体挽救手术的患者，糖尿病患者1年时的通畅率在统计学上接近显著优势（糖尿病患者为94±4%，而非糖尿病患者为79±8%；p = 0.056）。我们认为，糖尿病患者进行下肢动脉重建术时，血管再通和肢体挽救的成功率与非糖尿病患者相同。即使糖尿病患者存在组织坏死且更常需要旁路至胫后动脉，情况也是如此。
