Jensen L P, Schroeder T V, Lorentzen J E
Rigshospitalet, karkirurgisk afdeling RK., København.
Ugeskr Laeger. 1993 Sep 27;155(39):3115-8.
From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p = 0.005). Critical limb-ischaemia was more often present in diabetic than non-diabetic patients (DM:57%, NDM:36%, p = 0.0002). Diabetic patients had a significantly lower distal anastomosis than non-diabetic patients (p = 0.00001). There were no differences among diabetic and non-diabetic patients regarding three years primary and secondary patency (58% and 64% respectively), and regarding major amputations. However, the rate of minor amputations was higher in insulin-dependent compared with non-insulin-dependent diabetics, who in turn had a higher rate than non-diabetics (p < 0.00001). A markedly decreased survival rate was found in diabetics (p < 0.00005). We found the in situ bypass technique very useful in the treatment of critical ischaemia of the lower limb in diabetic patients. The overall results in diabetic patients, whether insulin-dependent or not, were equal to those in non-diabetic patients.
1986年至1990年期间，444例患者共接受了483例原位旁路手术。除吸烟习惯（糖尿病患者：48%，非糖尿病患者：64%，p = 0.002）和心脏病（糖尿病患者：45%，非糖尿病患者：29%，p = 0.005）外，糖尿病（DM）患者和非糖尿病（NDM）患者术前的风险因素分布相同。与非糖尿病患者相比，糖尿病患者更常出现严重肢体缺血（糖尿病患者：57%，非糖尿病患者：36%，p = 0.0002）。糖尿病患者的远端吻合口明显低于非糖尿病患者（p = 0.00001）。糖尿病患者和非糖尿病患者在三年的一期和二期通畅率（分别为58%和64%）以及大截肢方面没有差异。然而，胰岛素依赖型糖尿病患者的小截肢率高于非胰岛素依赖型糖尿病患者，而非胰岛素依赖型糖尿病患者的小截肢率又高于非糖尿病患者（p < 0.00001）。糖尿病患者的生存率显著降低（p < 0.00005）。我们发现原位旁路技术在治疗糖尿病患者下肢严重缺血方面非常有用。糖尿病患者（无论是否依赖胰岛素）的总体结果与非糖尿病患者相同。
