对血栓闭塞性脉管炎患者截肢平面的研究

Research of amputation plane in patients with thromboangiitis obliterans

摘要:

目的探讨自体外周血干细胞移植联合置管溶栓术重建血栓闭塞性脉管炎（TAO）患者的下肢血供并降低截肢平面的效果。方法回顾性分析2013 年10 月-2016 年6 月该中心收治的36 例拟截肢TAO患者（36 条患肢），采用自体外周血干细胞移植联合置管溶栓术治疗。结果干细胞移植4 周后27 例患者下肢疼痛、冷感评分、皮温及踝肱指数（ABI）均优于移植前（p <0.05），肢体溃疡、坏死处得到控制，呈干性坏疽；9 例患者无明显好转行截肢手术，移植前9 例截肢患者拟截肢平面：大腿下段2 例，膝关节4 例，小腿中上段3 例；实际截肢平面：膝关节4 例，小腿中上段2 例，小腿中段3 例。截肢率25%（9/36），降低截肢率75%，降低截肢平面率77.8%（7/9）。术后3 个月36 例患者行下肢DSA 检查，均形成不同程度的新生侧支血管，27 例保肢患者坏死范围局限，且呈干性坏疽；9 例截肢患者截肢处已愈合。36 例患者随访6～20 个月（平均12.2 个月）病情平稳；其中3 例保肢患者移植6 个月后因患肢疼痛、溃疡坏死加重，再次行自体外周血干细胞移植术，术后3 个月患肢症状好转。结论自体外周血干细胞移植联合置管溶栓术治疗TAO 患者可促进新生侧支血管形成并降低截肢平面。

Abstract:

To investigate the efficiency of autologous peripheral blood stem cells transplantation (ABSCT) combined with catheter-directed thrombolysis to rubuld the blood flow of patients with thromboangiitis obliterans (TAO) and reduce the amputation plane. Methods A retrospective analysis of 36 patients (36 limbs) with TAO who were prepared to amputate in the vascular surgery center of Yunnan province from Oct 2013 to June 2016 taking the treatment of ABSCT combined with Catheter-directed thrombolysis. Results Four weeks after the ABSCT, the scores of the legs pain and cold sensation, skin temperature, and ABI of 27 patients were better than before (p <0.05). Limb ulcer and necrosis were under control, which was dry gangrene. The other 9 patients had no obvious improvement and took amputation afterwards. Before ABSCT, the amputation planes of 9 patients were as followed: 2 cases in lower thighs, 4 cases in knee joints, and 3 cases in upper middle section of legs. While actual amputation planes were as followed: 4 cases in knee joints, 2 cases in upper middle section of legs, and 3 cases in middle section of legs. The amputation rate was 25% (9/36), reducing the amputation rate was 75%, and reducing the amputation plane rate was 77.8% (7/9). Three months after the ABSCT, 36 patients took limb DSA, which showed that all had formed different levels of new collateral vessels. The necrosis of 27 patients with limb salvage was undercontrol and dry gangrene. The wounds of 9 amputation patients were healed. 36 patients were followed up for 6 to 20 months (mean 12.2 months) and the symptoms were stable. Due to aggravated leg pain, foot ulcers and necrosis after 6 months, 3 patients with limb salvage had ABSCT again. Three months after the operation, the symptoms were improved. Conclusions Autologous peripheral blood stem cells transplantation combined with catheter-directed thrombolysis in patients with thromboangiitis obliterans can promote the restruction of blood flow and reduce the amputation plane.