对血栓闭塞性脉管炎患者截肢平面的研究

发布时间：2018-06-25 07:48

本文选题：外周血干细胞 + 自体移植　；参考：《中国现代医学杂志》2017年15期

【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(P0.05),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]:Objective to investigate the effect of autologous peripheral blood stem cell transplantation combined with catheter thrombolysis for the reconstruction of lower limb blood supply and lower amputation level in patients with thrombotic vasculitis obliterans (TAO). Methods a retrospective analysis of 36 cases of amputated TAO patients (36 affected limbs) in the center of October 2013, -2016 years, was analyzed retrospectively. Autologous peripheral blood stem cell transplantation combined with catheterization was used. Results 4 weeks after the stem cell transplantation, 27 patients had lower limb pain, the cold sense score, the skin temperature and the ankle brachial index (ABI) were superior to those before the transplantation (P0.05), the limb ulcers, the necrosis and the dry gangrene, 9 patients had no obvious amputation operation, and 9 amputated amputations before transplantation: 2 cases in the lower thighs and 4 knee joints. 3 cases of the upper middle leg, 4 cases of knee joint, 2 cases in the upper part of the calf, 3 cases in the middle leg, 25% amputation rate (9/36), 75% amputation rate, lower amputation rate 77.8% (7/9). 3 months after operation, 36 cases of the lower limb DSA examination, the formation of different degree of new collateral vessels, 27 cases of limb necrosis area limited, and dry bad 9 cases of amputation patients with amputation at the amputation section of 9 cases were followed up for 6~20 months (average 12.2 months), and 3 cases of limb salvage patients were treated with limb pain and aggravated ulcer necrosis after 6 months of transplantation. Autologous peripheral blood stem cell transplantation was performed again, and the limb symptoms were well converted in 3 months after operation. Conclusion autologous peripheral blood stem cell transplantation combined with catheter thrombolysis. Surgical treatment of TAO patients can promote the formation of new collateral vessels and reduce the amputation level.
【作者单位】：昆明医科大学第四附属医院(云南省第二人民医院)血管外科中心;
【基金】：云南省自然科学基金(No:2013FB183,2014FZ041)
【分类号】：R654.4

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