下肢动脉成形术术后再狭窄与中医体质相关性研究
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摘要
背景：
随着现代医学的发展,各种新技术、新材料的不断更新,下肢动脉硬化闭塞症治疗的重点,已从开放手术向腔内治疗转移。我们通过对于2007年6月-2011年3月采用下肢动脉成形术治疗173例下肢动脉硬化闭塞症,通过术后随访,在明确介入治疗疗效的同时,分析术后再狭窄因素并对再狭窄患者的中医体质进行了辨识。
目的：
分析血管腔内介入治疗下肢动脉闭塞性病变的疗效,并探讨术后再狭窄率以及相关因素,初步探讨下肢动脉成形术术后病人中医体质分布规律,为中医药防治动脉成形术术后再狭窄提供理论依据。
方法：
选取105例来自广州中医药大学第二附属医院(广东省中医院)介入科、内分泌科、血管外科符合条件的患者；男63例,女42例；年龄29-90岁,平均年龄71.3岁；合并糖尿病100例,高血压病78例,冠心病63例,高脂血症75例,脑梗死32例。所有患者中共有173条患肢均经彩超、下肢动脉CT平扫+增强+三维重建或(和)血管造影证实存在下肢动脉病变,其中以髂动脉为主者32例,股胭动脉为主53例,膝下动脉为主88例。造影结果单侧肢体动脉病变37例,双侧下肢动脉病变68例；单纯血管狭窄病变49例,长节段完全闭塞性血管病变(长度>6cm)90例,短节段完全闭塞(长度<6cm)34例。观察治疗前后下肢临床症状(间歇性跛行、静息痛、缺血发生溃疡等)、肢体创面、步行速度等变化。术后观察手术成功率,随访期间观察再狭窄率、截肢率、中医体质类型等。
结果：
介入手术成功率为95.38%(165／173)。术后3月、6月、9月、1年再狭窄率分别为7.27%(12／165)、20.00%(33／165)、27.27%(45／165)、41.82%(69／165)；中医体质辨识中血瘀型体质35.38%(23／65)、痰湿型体质29.23%(19／65)、湿热型18.46%(12／65)、阳虚体质16.92%(11／65),随访患者中无其余5种体质类型。
结论：
下肢动脉成形术治疗下肢动脉硬化闭塞症临床疗效确切,是治疗该病的一种有效手段,其改善了下肢缺血引起的症状,减少了截肢率,未发现严重的毒副、并发症反应,有临床推广应用价值；中医体质辨识中,血瘀型、痰湿型、湿热型、阳虚型体质最为常见,对于此4种体质类型的患者应提供更积极、更有针对性的中药调摄体质和防治再狭窄。
Background
Along with the development of modern medicine and update of kinds of new technology and new material, the focus of therapy for lower limb arteriosclerosis block disease has from the open surgery to cavity treatment. We explore the effect of treatment, analysis the factors of resetenosis and identify the correlation of resetenosis and TCM Constitution through the postoperative follow-up of patients by using lower extremity artery angioplasty in June,2007-March,2011.
Purpose
Anglysis the curative effect of angioplasty for lower extremity artery.Investigate the rate, the factors and TCM Constitution of restenosis for providing a theoretical basis to prevent and treat the restenosis with the traditional Chinese medicine.
Methods
Select105cases from endocrinology, vascular surgery of The Second Affiliated Hospital of Guang Dong University of Chinese Medicine (Guang Dong Province Traditional Chinese Medical Hosputal);63males,42femals;aged29to90, mean age71.3; in78cases with hypertension, coronary heart disease in63cases,75cases of hyperlipemia, cerebral infarction in32cases. All patients of the173limbs were treated by color Doppler ultrasound, lower extremity arterial unenhanced CT+enhanced+3D reconstruction or (and) angiography confirmed the presence of lower extremity arterial disease, which mainly to iliac artery in32cases,53cases of femoral popliteal artery, inferior genicular artery88cases. Angiographic findings of unilateral limb arterial lesions in37cases, bilateral lower extremity arterial lesions in68cases; simple vascular stenosis in49cases, long segment completely occlusive vasculopathy (length>6cm) in90cases, short segment occlusion (length <6cm) in34cases. The clinical symptoms were observed before and after treatment of lower extremity (intermittent claudication, rest pain, ischemia occurring ulcers), limb wound, limb peripheral blood circulation and flow chart, walking speed change. Postoperative observation operation success rate, follow-up observed during restenosis rates, rates of amputation, TCM Constitution Types
Results
The success rate of Interventional operation is95.38%(165/173). Three monthes, six monthes, nine monthes, one year of restenosis rates were7.27%(12/165),20%(33/165),27.27%(45/165),41.82%(69/165). Traditional Chinese medicine constitution identification:Xueyu35.38%(23/65), Tanshi29.23%(19/65), Shire18.46%(12/65), Yangxu16.92%(11/65), and follow-up of patients without the remaining5constitution type in the65cases of restenosis of69blood vessels after one year.
Conclusions
Lower extremity arterial angioplasty in the treatment of lower limb arterial occlusive disease has the good clinical efficacy, and it is a kind of effective means, which improves lower limb ischemia caused by symptoms, reduces the amputation rate, and does not be found serious toxic reactions, complications, clinical application value; postoperative follow-up revealed that raditionalChinese medicine constitution identification:Xueyu, Tanshi, Shire, Yangxu are the most common, the four constitution types of patients should provide more active, more targeted Chinese medicine promoting physical and prevention restenosis.
随着现代医学的发展,各种新技术、新材料的不断更新,下肢动脉硬化闭塞症治疗的重点,已从开放手术向腔内治疗转移。我们通过对于2007年6月-2011年3月采用下肢动脉成形术治疗173例下肢动脉硬化闭塞症,通过术后随访,在明确介入治疗疗效的同时,分析术后再狭窄因素并对再狭窄患者的中医体质进行了辨识。
目的：
分析血管腔内介入治疗下肢动脉闭塞性病变的疗效,并探讨术后再狭窄率以及相关因素,初步探讨下肢动脉成形术术后病人中医体质分布规律,为中医药防治动脉成形术术后再狭窄提供理论依据。
方法：
选取105例来自广州中医药大学第二附属医院(广东省中医院)介入科、内分泌科、血管外科符合条件的患者；男63例,女42例；年龄29-90岁,平均年龄71.3岁；合并糖尿病100例,高血压病78例,冠心病63例,高脂血症75例,脑梗死32例。所有患者中共有173条患肢均经彩超、下肢动脉CT平扫+增强+三维重建或(和)血管造影证实存在下肢动脉病变,其中以髂动脉为主者32例,股胭动脉为主53例,膝下动脉为主88例。造影结果单侧肢体动脉病变37例,双侧下肢动脉病变68例；单纯血管狭窄病变49例,长节段完全闭塞性血管病变(长度>6cm)90例,短节段完全闭塞(长度<6cm)34例。观察治疗前后下肢临床症状(间歇性跛行、静息痛、缺血发生溃疡等)、肢体创面、步行速度等变化。术后观察手术成功率,随访期间观察再狭窄率、截肢率、中医体质类型等。
结果：
介入手术成功率为95.38%(165／173)。术后3月、6月、9月、1年再狭窄率分别为7.27%(12／165)、20.00%(33／165)、27.27%(45／165)、41.82%(69／165)；中医体质辨识中血瘀型体质35.38%(23／65)、痰湿型体质29.23%(19／65)、湿热型18.46%(12／65)、阳虚体质16.92%(11／65),随访患者中无其余5种体质类型。
结论：
下肢动脉成形术治疗下肢动脉硬化闭塞症临床疗效确切,是治疗该病的一种有效手段,其改善了下肢缺血引起的症状,减少了截肢率,未发现严重的毒副、并发症反应,有临床推广应用价值；中医体质辨识中,血瘀型、痰湿型、湿热型、阳虚型体质最为常见,对于此4种体质类型的患者应提供更积极、更有针对性的中药调摄体质和防治再狭窄。
Background
Along with the development of modern medicine and update of kinds of new technology and new material, the focus of therapy for lower limb arteriosclerosis block disease has from the open surgery to cavity treatment. We explore the effect of treatment, analysis the factors of resetenosis and identify the correlation of resetenosis and TCM Constitution through the postoperative follow-up of patients by using lower extremity artery angioplasty in June,2007-March,2011.
Purpose
Anglysis the curative effect of angioplasty for lower extremity artery.Investigate the rate, the factors and TCM Constitution of restenosis for providing a theoretical basis to prevent and treat the restenosis with the traditional Chinese medicine.
Methods
Select105cases from endocrinology, vascular surgery of The Second Affiliated Hospital of Guang Dong University of Chinese Medicine (Guang Dong Province Traditional Chinese Medical Hosputal);63males,42femals;aged29to90, mean age71.3; in78cases with hypertension, coronary heart disease in63cases,75cases of hyperlipemia, cerebral infarction in32cases. All patients of the173limbs were treated by color Doppler ultrasound, lower extremity arterial unenhanced CT+enhanced+3D reconstruction or (and) angiography confirmed the presence of lower extremity arterial disease, which mainly to iliac artery in32cases,53cases of femoral popliteal artery, inferior genicular artery88cases. Angiographic findings of unilateral limb arterial lesions in37cases, bilateral lower extremity arterial lesions in68cases; simple vascular stenosis in49cases, long segment completely occlusive vasculopathy (length>6cm) in90cases, short segment occlusion (length <6cm) in34cases. The clinical symptoms were observed before and after treatment of lower extremity (intermittent claudication, rest pain, ischemia occurring ulcers), limb wound, limb peripheral blood circulation and flow chart, walking speed change. Postoperative observation operation success rate, follow-up observed during restenosis rates, rates of amputation, TCM Constitution Types
Results
The success rate of Interventional operation is95.38%(165/173). Three monthes, six monthes, nine monthes, one year of restenosis rates were7.27%(12/165),20%(33/165),27.27%(45/165),41.82%(69/165). Traditional Chinese medicine constitution identification:Xueyu35.38%(23/65), Tanshi29.23%(19/65), Shire18.46%(12/65), Yangxu16.92%(11/65), and follow-up of patients without the remaining5constitution type in the65cases of restenosis of69blood vessels after one year.
Conclusions
Lower extremity arterial angioplasty in the treatment of lower limb arterial occlusive disease has the good clinical efficacy, and it is a kind of effective means, which improves lower limb ischemia caused by symptoms, reduces the amputation rate, and does not be found serious toxic reactions, complications, clinical application value; postoperative follow-up revealed that raditionalChinese medicine constitution identification:Xueyu, Tanshi, Shire, Yangxu are the most common, the four constitution types of patients should provide more active, more targeted Chinese medicine promoting physical and prevention restenosis.
引文
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[2]Graziani L, Silvestro A, Bertone V, etal. Vascular involvement in diabetic subjects with ischemic foot ulcer:a new morphologic categorization of disease severity [J]. Eur J Vase Endovase Surg,2007,33(4):453-460.
[3]卫生部心血管病防治研究中心.外周血管病。见：中国,心血管病报告2005[M].第一版.中国大百科全书出版社,2006.108--109.
[4]Norgren L, Hiatt WR, Dormand) JA, etal. Inter-Society Consensus for the Management of Peripheral Arterial Disease(TASC Ⅱ) [J]Eur J Vase Endovasc Surg,2007,33(suppl): S1-$75.
[5]Apelqvist J, Bakker K, Van Houtum WH, etal. International consensus and prac|ial guidelines on the managent and the prevention of the diabetic foot. International Working Gorking Group on the Diabetic Foot. Diabetes. Metab Res Rew,2000,16(suppl 1):84-92.
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