Bosma Jan, Vahl Anco, Wisselink Willem
Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Ann Vasc Surg. 2013 Nov;27(8):1105-14. doi: 10.1016/j.avsg.2013.01.010. Epub 2013 Aug 26.
The purpose of this study was to assess the effect of revascularization (bypass surgery, angioplasty) and primary amputation on health-related quality of life (QoL) in patients with critical limb ischemia (CLI; resting pain or tissue loss).
A systematic review of the literature was performed through an electronic search of PubMed (from 1985 to 2012) and Embase (from 1985 to 2012) by two independent investigators to identify English-language articles investigating health-related QoL in regard to CLI.
Three observational studies were identified describing a comparison between primary amputation and revascularization and their effects on QoL in patients with CLI, all concluding that revascularization should be attempted. Data pooling was omitted due to the impossibility of combining outcome parameters. A separate analysis of each article is presented.
Patients with CLI have poor health prospects and life expectancy, irrespective of treatment administered. Randomized trials of health-related QoL after revascularization versus primary amputation are nonexistent. Also, the available observational studies do not allow sound conclusions, due to small numbers and methodologic imperfections. Therefore, no recommendations of either therapy in patients with CLI can be made with respect to an anticipated improvement in QoL.
本研究旨在评估血运重建术（搭桥手术、血管成形术）和一期截肢术对严重肢体缺血（CLI；静息痛或组织缺失）患者健康相关生活质量（QoL）的影响。
两名独立研究人员通过对PubMed（1985年至2012年）和Embase（1985年至2012年）进行电子检索，对文献进行系统综述，以识别调查与CLI相关的健康相关QoL的英文文章。
确定了三项观察性研究，描述了一期截肢术和血运重建术之间的比较及其对CLI患者QoL的影响，所有研究均得出应尝试进行血运重建术的结论。由于无法合并结果参数，故未进行数据合并。对每篇文章进行了单独分析。
无论接受何种治疗，CLI患者的健康前景和预期寿命都很差。不存在关于血运重建术与一期截肢术后健康相关QoL的随机试验。此外，由于样本量小和方法学上的缺陷，现有的观察性研究无法得出可靠结论。因此，就预期的QoL改善而言，无法对CLI患者的任何一种治疗方法提出建议。
