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中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (04) : 269 -273. doi: 10.3877/cma.j.issn.1673-9450.2017.04.005

所属专题: 经典病例 文献

论著

糖尿病足溃疡403例的修复体会
刘小龙1,(), 苏福增1, 查天建1, 刘利华1, 陈召1, 王智忠1, 努尔兰1   
  1. 1. 830001 乌鲁木齐,新疆维吾尔自治区人民医院烧伤、创面修复外科
  • 收稿日期:2017-04-12 出版日期:2017-08-01
  • 通信作者: 刘小龙
  • 基金资助:
    乌鲁木齐市科学技术计划项目(Y131310006)

Repair of 403 patients of diabetic foot ulcer

Xiaolong Liu1,(), Fuzeng Su1, Tianjian Zha1, Lihua Liu1, Zhao Chen1, Zhizhong Wang1, erlan Nu1   

  1. 1. Department of Burns, Wound Repair Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumuqi 830001, China
  • Received:2017-04-12 Published:2017-08-01
  • Corresponding author: Xiaolong Liu
  • About author:
    Corresponding author: Liu Xiaolong, Email:
引用本文:

刘小龙, 苏福增, 查天建, 刘利华, 陈召, 王智忠, 努尔兰. 糖尿病足溃疡403例的修复体会[J]. 中华损伤与修复杂志(电子版), 2017, 12(04): 269-273.

Xiaolong Liu, Fuzeng Su, Tianjian Zha, Lihua Liu, Zhao Chen, Zhizhong Wang, erlan Nu. Repair of 403 patients of diabetic foot ulcer[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(04): 269-273.

目的

探讨糖尿病足溃疡(DFU)的诊疗方案及经验。

方法

分析新疆维吾尔自治区人民医院2014年1月至2015年12月间收治的403例DFU患者的病例资料,其中Wagner分级Ⅰ、Ⅱ级的DFU患者主要采用换药、局部注射胰岛素、负压封闭引流以及生物敷料覆盖等保守治疗措施;Wagner分级Ⅲ、Ⅳ、Ⅴ级的DFU患者,或合并严重双下肢动脉硬化闭塞症的患者采用手术治疗,主要包括清创、植皮、皮瓣转移修复、截肢(趾)等。

结果

本组患者住院期间无死亡,无严重并发症出现,其中保守治疗125例,一期清创后封闭创面者170例,采用多种方法综合治疗者108例,所有患者均创面愈合良好后出院。随访时间为10个月,随访过程中复发32例,慢性疼痛26例,并发全身多器官功能衰竭死亡2例。

结论

对于DFU足的治疗单一方法是难以奏效的,必须采取综合治疗的多种手段才能达到治愈创面的目的。

Objective

To discuss the diagnosis and treatment of diabetic foot ulcer diabetic foot ulcer (DFU) and experience.

Methods

From January 2014 to December 2015, all 403 patients of DFU were analysed in the People′s Hospital of Xinjiang Uygur Autonomous Region. The patients of DFU in Wagner classificationⅠ and Ⅱ were mainly treated with wound dressing, local injection of insulin, negative pressure closed drainage and biological dressing coverage and other conservative measures. The patients of DFU in Wagner classification Ⅲ, Ⅳ and Ⅴ or combined with severe lower extremity arteriosclerosis obliterans were mainly treated with surgery, such as debridement, skin grafting, flap transfer repair, amputation (toe) and so on.

Results

There were no perioperative deaths and serious complications during hospitalization. Among them, there were 125 cases of conservative treatment, and 170 patients were treated with debridement, a total of 108 patients were treated with various methods. All the patients were well healed and discharged. The median follow-up was 10 months, 32 patients were recurrence, 26 patients were chronic pain and 2 patients were died of multiple organ dysfunction syndrome during follow-up.

Conclusion

A single treatment of DFU is difficult to work, a variety of means of comprehensive treatment would will have been taken to achieve the purpose of wound healing.

图1 患者男,43岁,右足跟破溃流脓,行清创、负压封闭引流后肉芽组织生长良好
图2 患者女,57岁,右足趾破溃流脓,行右足趾清创及截趾术,一期缝合创面,愈合良好
图3 患者男,51岁,右足背破溃坏死10 d,行右足背部清创术,右小腿供瓣、右足背皮瓣转移修复术,负压封闭引流持续吸引,继续间断换药,创面愈合良好
1
Chiraniya S, Shejol D, Bhagat V, et al. Study of risk factors and outcome of patients with diabetic foot ulcers[J]. Assoc Physicians India, 2016, 64(1):92.
2
关小宏. 糖尿病足病的治疗与预防[J/CD]. 中华损伤与修复杂志(电子版), 2014, 10(2):98-102.
3
Dunyach-Remy C, Courtais-Coulon C, DeMattei C, et al. Link between nasal carriage of Staphylococcus aureus and infected diabetic foot ulcers[J]. Diabetes Metab, 2017, 43(2):167-171.
4
关小宏,杨彩哲,吴石白. 糖尿病足感染的特点与治疗[J]. 中华医院感染学杂志,2012, 22(19):4237-4239.
5
张兆新,刘小龙,吕磊,等. 糖尿病足溃疡患者创面局部注射胰岛素对全身血糖及创面的影响[J]. 中华烧伤杂志,2011, 27(6):451-455.
6
Orgill DP, Bayer LR. Negative pressure wound therapy: past, present and future[J]. Int Wound J, 2013, 10 Suppl 1:15-19.
7
张兆新,刘小龙,吕磊,等. 同种异体皮在糖尿病足溃疡患者创面修复中的应用[J]. 中华烧伤杂志,2017, 27(3):218-219.
8
张兆新,吕磊,刘小龙,等. 异种脱细胞真皮基质在难愈性创面修复中的应用研究[J/CD]. 中华损伤与修复杂志(电子版), 2011, 6(6):894-901.
9
肖厚安,凡孝菊,周小茜,等. 利用组织工程双层皮肤修复糖尿病溃疡的研究[J/CD].中华损伤与修复杂志(电子版), 2014, 9(3):272-276.
10
努尔兰,刘小龙,买斯吾提,等. 多种皮瓣修复难愈性创面[J/CD]. 中华损伤与修复杂志(电子版), 2013, 8(6):622-624.
11
Fauzi AA, Chung TY, Latif LA. Risk factors of diabetic foot charcot arthropathy: a case-control study at a Malaysian tertiary care centre[J].Singapore Med J, 2016, 57(4):198-203.
12
Schintler MV. Negative pressure therapy:theory and practice[J]. Diabetes Metab Res Rev, 2012, 28 Suppl 1:72-77.
13
Jansen RB, Svendsen OL, Kirketerp-Møller K. Clinical management of acute diabetic Charcot foot in Denmark[J]. Dan Med J, 2016, 63(10). pii:A5273
14
关小宏. 糖尿病足发展史[J/CD]. 中华损伤与修复杂志(电子版), 2011, 6(4):509-515.
15
Ammendola M, Sacco R, Butrico L, et al. The care of transmetatarsal amputation in diabetic foot gangrene[J]. Int Wound J, 2017, 14(1):9-15.
16
Martinson M, Martinson N. A comparative analysis of skin substitutes used in the management of diabetic foot ulcers[J]. J Wound Care, 2016, 25(Sup 10):S8-S17.
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