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中华损伤与修复杂志(电子版) ›› 2020, Vol. 15 ›› Issue (04) : 256 -263. doi: 10.3877/cma.j.issn.1673-9450.2020.04.005

所属专题： 文献； 指南共识；

指南与共识

糖尿病足合并难愈性创面外科治疗全国专家共识（2020版）
郭光华1,†(), 朱峰2, 闵定宏1, 黄跃生3,†(), 吴军4   
  1. 1. 南昌大学第一附属医院
    2. 海军军医大学第一附属医院
    3. 深圳市人民医院（南方科技大学第一附属医院，暨南大学第二临床医学院）
    4. 深圳市第二人民医院（深圳大学第一附属医院）
  • 收稿日期:2020-07-12 出版日期:2020-08-01
  • 通信作者: 郭光华, 黄跃生

National expert consensus on surgical treatment of diabetic foot complicated with refractory wounds (2020 version)

Guanghua Guo1,†(), Feng Zhu2, Dinghong Min1, Yuesheng Huang3,†(), Jun Wu4   

  1. 1. First Affiliated Hospital of Nanchang University
    2. First Affiliated Hospital, Naval Military Medical University
    3. Shenzhen People′s Hospital (First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University)
    4. Shenzhen Second People′s Hospital, First Affiliated Hospital of Shenzhen University
  • Received:2020-07-12 Published:2020-08-01
  • Corresponding author: Guanghua Guo, Yuesheng Huang
  • About author:

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    Corresponding author: Guo Guanghua, 330006 Nanchang, Department of Burns, First Affiliated Hospital of Nanchang University, Email: ;
    Huang Yuesheng, 518020 Shenzhen, Department of Wound Repair, Institute of Wound Repair, Shenzhen People′s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Email:
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郭光华, 朱峰, 闵定宏, 黄跃生, 吴军. 糖尿病足合并难愈性创面外科治疗全国专家共识（2020版）[J]. 中华损伤与修复杂志(电子版), 2020, 15(04): 256-263.

Guanghua Guo, Feng Zhu, Dinghong Min, Yuesheng Huang, Jun Wu. National expert consensus on surgical treatment of diabetic foot complicated with refractory wounds (2020 version)[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(04): 256-263.

糖尿病足溃疡是糖尿病最常见、最严重的并发症。周围神经病变、周围动脉疾病和创伤是导致足部溃疡发生的主要因素，而创面愈合不良又可引起慢性创面的发生，常导致截肢。虽然多学科治疗已成为广泛的共识，但及时采取有效的外科干预，可以控制创面感染，促进创面愈合，减少截肢发生率。为规范糖尿病足创面外科治疗，专家组主要从局部辅助治疗、介入治疗、血管重建、清创和手术治疗等方面进行讨论形成了共识，为临床相关专科的医护人员提供参考。

关键词: 糖尿病, 糖尿病足溃疡, 外科治疗, 创面愈合, 共识

Diabetic foot ulcer is the most common and serious complications of diabetes. Peripheral neuropathy, peripheral artery disease and trauma are the main factors leading to foot ulcers, and poor wound healing can lead to the occurrence of chronic wounds, often leading to amputation. Although multidisciplinary treatment has become a widespread consensus, timely and effective surgical intervention can control wound infection, promote wound healing and reduce the incidence of amputation. In order to standardize the surgical treatment of diabetic foot wounds, the expert group mainly discussed and reached a consensus from the aspects of local adjuvant therapy, interventional therapy, vascular reconstruction, debridement and surgical treatment, providing reference for medical staff in relevant clinical specialties.

Key words: Diabetes, Diabetic foot ulcer, Surgical treatment, Wound healing, Consensus
[1]
Mavrogenis AF, Megaloikonomos PD, Antoniadou T, et al. Current concepts for the evaluation and management of diabetic foot ulcers[J]. EFORT Open Rev, 2018, 3(9): 513-525.
[2]
Forsythe RO, Hinchliffe RJ. Assessment of foot perfusion in patients with a diabetic foot ulcer[J]. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 232-238.
[3]
Bakker K, Apelqvist J, Lipsky BA, et al. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus[J]. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 2-6.
[4]
中华医学会糖尿病学分会，中华医学会感染病学分会，中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅰ)[J]. 中华糖尿病杂志，2019, 11(2): 92-108.
[5]
付小兵. 构建一个创面治疗学科体系：中国特色创面治疗中心建设20年的回顾与展望[J]. 中华烧伤杂志，2018, 34(12): 859-836.
[6]
Wagner FW Jr. The dysvascular foot: a system for diagnosis and treatment[J]. Foot Ankle, 1981, 2(2): 64-122.
[7]
Aboyans V, Ricco JB, Bartelink MEL, et al. Editor′s Choice -2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2018, 55(3): 305-368.
[8]
中国糖尿病足细胞与介入治疗技术联盟，中国介入医师分会介入医学与生物工程技术委员会. 糖尿病足介入综合诊治临床指南(第五版)[J]. 介入放射学杂志，2019, 28(3): 205-216.
[9]
刘晓，高静，李晓岚，等. 糖尿病足下肢动脉病变的介入治疗效果分析[J/CD]. 中国医学前沿杂志(电子版), 2015, 7(12): 21-25.
[10]
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer[J]. World J Diabetes, 2015, 6(1): 37-53.
[11]
谷涌泉，张建，汪忠镐，等. 糖尿病性下肢缺血的外科治疗[J]. 中华糖尿病杂志，2004, 12(5): 328-331.
[12]
Pedrajas FG, Cafasso DE, Schneider PA. Endovascular therapy: is it effective in the diabetic limb？[J]. Semin Vasc Surg, 2012, 25(2): 93-101.
[13]
Viswanathan V, Kesavan R, Kavitha KV, et al. A pilot study on the effects of a polyherbal formulation cream on diabetic foot ulcers[J]. Indian J Med Res, 2011, 134(2): 168-173.
[14]
Kavitha KV, Tiwari S, Purandare VB, et al. Choice of wound care in diabetic foot ulcer: A practical approach[J]. World J Diabetes, 2014, 5(4): 546-556.
[15]
Oliveira N, Rosa P, Borges L, et al. Treatment of diabetic foot complications with hyperbaric oxygen therapy: a retrospective experience[J]. Foot Ankle Surg, 2014, 20(2): 140-143.
[16]
Thakral G, Lafontaine J, Najafi B, et al. Electrical stimulation to accelerate wound healing[J]. Diabet Foot Ankle, 2013: 4.
[17]
Barnes R, Shahin Y, Gohil R, et al. Electrical stimulation vs. standard care for chronic ulcer healing: a systematic review and meta-analysis of randomised controlled trials[J]. Eur J Clin Invest, 2014, 44(4): 429-440.
[18]
中国医疗保健国际交流促进会糖尿病足病分会. 中国糖尿病足诊治指南[J]. 中华医学杂志，2017, 97(4): 251-258.
[19]
Jain AC. Amit Jain′s Modified Grading System For Debridement In Diabetic Lower Limb[J]. International Journal Of Medical Science And Clinical Inventions, 2016, 3(9): 2193-2195.
[20]
Wilcox JR, Carter MJ, Covington S. Frequency of debridements and time to heal: a retrospective cohort study of 312 744 wounds[J]. JAMA Dermatol, 2013, 149(9): 1050-1058.
[21]
Moura LI, Dias AM, Carvalho E, et al. Recent advances on the development of wound dressings for diabetic foot ulcer treatment--a review[J]. Acta Biomater, 2013, 9(7): 7093-7114.
[22]
中华医学会糖尿病学分会，中华医学会感染病学分会，中华医学会组织修复与再生分会. 中国糖尿病足防治指南(2019版)(Ⅱ)[J]. 中华糖尿病杂志，2019, 11(3): 161-189.
[23]
Teng YJ, Li YP, Wang JW, et al. Bioengineered skin in diabetic foot ulcers[J]. Diabetes Obes Metab, 2010, 12(4): 307-315.
[24]
谢闪亮，郭光华，闵定宏. 封闭负压引流技术在创面愈合中的应用及机制研究进展[J]. 中华烧伤杂志，2017, 33(6): 397-400.
[25]
Richmond NA, Vivas AC, Kirsner RS. Topical and biologic therapies for diabetic foot ulcers[J]. Med Clin North Am, 2013, 97(5): 883-898.
[26]
Zeng X, Tang Y, Hu K, et al. Three-week topical treatment with placenta-derived mesenchymal stem cells hydrogel in a patient with diabetic foot ulcer: A case report[J]. Medicine (Baltimore), 2017, 96(51): e9212.
[27]
中国微循环学会周围血管疾病专业委员会糖尿病足学组. 糖尿病足创面修复治疗专家共识[J]. 中华糖尿病杂志，2018, 10(5): 305-309.
[28]
马婧，冉兴无. 糖尿病足的规范化诊断与治疗[J]. 中华内科杂志，2016, 55(8): 648-650.
[29]
Game FL, Apelqvist J, Attinger C, et al. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review[J]. Diabetes Metab Res Rev, 2016, 32 Suppl 1: 154-168.
[30]
姜玉峰，许樟荣，付小兵. 糖尿病足创面修复过程中清创问题[J]. 中国实用内科杂志，2016, 36(1): 13-15.
[31]
侯念宗，宋卫东，陈皓，等. 负压封闭引流联合腓肠神经营养血管皮瓣修复糖尿病足创面疗效研究[J]. 国际骨科学杂志，2012, 33(4): 272-274.
[32]
孙迎放. 糖尿病足外科治疗的相关问题[J/CD]. 中华损伤与修复杂志(电子版), 2012, 7(2): 7-10.
[33]
石鸿雁，许樟荣. 糖尿病夏科足国际专家共识介绍[J]. 中华糖尿病杂志，2012, 4(4): 252-254.
[34]
Pinzur M. surgical versus accommodative treatment for Charcot arthropathy of the midfoot[J]. Foot Ankle Int, 2004, 25(8): 545-549.
[35]
花奇凯，秦泗河，赵良军，等. Ilizarov技术胫骨横向骨搬移术治疗糖尿病足[J]. 中国矫形外科杂志，2017, 25(4): 303-307.
[36]
Matsen FA 3rd, Wyss CR, Robertson CL, et al. The relationship of transcutaneous PO2 and laser Doppler measurements in a human model of local arterial insufficiency[J]. Surg Gynecol Obstet, 1984, 159(5): 418-422.
[37]
Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine[J]. J Vasc Surg, 2016, 63(2 Suppl): 3S-21S.
[38]
中华医学会内分泌学分会. 中国成人2型糖尿病HbA1c控制目标的专家共识[J]．中华内分泌代谢杂志，2011, 27(5): 372-374.
[39]
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志，2018, 38(4): 292-344.
[40]
中国心脏重症专家委员会，北京高血压防治协会. 心脏重症相关高血压管理专家共识[J]. 中华医学杂志，2019, 99(13): 965-970.
[41]
Keeling D, Tait RC, Watson H, et al. Peri-operative management of anticoagulation and antiplatelet therapy[J]. Br J Haematol, 2016, 175(4): 602-613.
[42]
Gharaibeh L, Albsoul-Younes A, Younes N. Evaluation of VTE Prophylaxis in an Educational Hospital: Comparison Between the Institutional Guideline (Caprini 2006) and the ACCP Guideline (Ninth Edition)[J]. Clin Appl Thromb Hemost, 2016, 22(7): 627-632.
[43]
Robertson L, Ghouri MA, Kovacs F. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment[J]. Cochrane Database Syst Rev, 2012, 2012(8): CD002071.
[44]
Katsanos K, Spiliopoulos S, Saha P, et al. Comparative efficacy and safety of different antiplatelet agents for prevention of major cardiovascular events and leg amputations in patients with peripheral arterial disease: a systematic review and network meta-analysis[J]. PLoS One, 2015, 10(8): e0135692.
[45]
van Veen JJ, Makris M. Management of peri-operative anti-thrombotic therapy[J]. Anaesthesia, 2015, 70 Suppl 1: 58-67, e21-e23.
[46]
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report[J]. Chest, 2016, 149(2): 315-352.
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