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糖尿病合并外周动脉疾病患者足部溃疡血运重建的疗效:系统评价。

Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review.

机构信息

St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.

Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA, USA.

出版信息

Diabetes Metab Res Rev. 2016 Jan;32 Suppl 1:136-44. doi: 10.1002/dmrr.2705.

Abstract

Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014. Only clinically relevant outcomes were assessed. The research conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and Scottish Intercollegiate Guidelines Network methodological scores were assigned. A total of 56 articles were eligible for full-text review. There were no randomized controlled trials, but there were four nonrandomized studies with a control group. The major outcomes following endovascular or open bypass surgery were broadly similar among the studies. Following open surgery, the 1-year limb salvage rates were a median of 85% (interquartile range of 80-90%), and following endovascular revascularization, these rates were 78% (70-89%). At 1-year follow-up, 60% or more of ulcers had healed following revascularization with either open bypass surgery or endovascular techniques. Studies appeared to demonstrate improved rates of limb salvage associated with revascularization compared with the results of conservatively treated patients in the literature. There were insufficient data to recommend one method of revascularization over another. There is a real need for standardized reporting of baseline demographic data, severity of disease and outcome reporting in this group of patients.

摘要

外周动脉疾病(PAD)的症状或体征在糖尿病足溃疡患者中高达 50%,是愈合不良和截肢的危险因素。2012 年,国际糖尿病足工作组的一个多学科工作组发表了一篇关于糖尿病和 PAD 患者溃疡足血运重建效果的系统评价。这篇出版物是对该综述的更新,现在包括了从 1980 年到 2014 年 6 月对糖尿病和 PAD 患者溃疡足血运重建治疗方法进行系统搜索的结果。仅评估了临床相关的结果。该研究符合系统评价和荟萃分析的首选报告项目指南,并被赋予苏格兰校际指南网络方法学评分。共有 56 篇文章符合全文审查条件。没有随机对照试验,但有 4 项非随机对照试验和 1 项对照组研究。血管内或开放旁路手术后的主要结果在研究中大致相似。开放手术后,1 年肢体存活率中位数为 85%(四分位间距为 80-90%),血管内血运重建后为 78%(70-89%)。在 1 年随访时,血管内开放旁路手术或血管内技术治疗后,60%或更多的溃疡愈合。与文献中保守治疗患者的结果相比,血管重建似乎显示出更高的肢体存活率。没有足够的数据推荐一种血管重建方法优于另一种。在这组患者中,确实需要标准化报告基线人口统计学数据、疾病严重程度和结果报告。

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