自体外周血干细胞移植联合置管溶栓术治疗TAO患者血流重建并降低截肢平面

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2014年10月至2016年6月云南省血管外科中心收治的16例TAO患者(16条患肢),采用自体外周血于细胞移植联合置管溶栓术治疗.结果 16例患者(16条患肢)于细胞移植4周后下肢疼痛、冷感评分均优于移植前(P＜0.05),变温带较前分别下降2 ～ 10 cm,其中2例患者足趾坏死及足背缺血情况未加重.移植后3个月,1例患者坏死局限于足趾区,1例坏死局限于足背中段,均呈干性坏疽,行局部截肢手术,截肢平面以上皮温、皮色良好;14例保肢患者患肢皮温由(26.68 ±0.51)℃增加到(31.45±0.49)℃,间歇性跛行距离由(80.59±46.45)m增加到(332.45±150.23)功,ABI由0.42±0.02增加到0.78±0.04,3项指标移植后均优于移植前(P＜0.05);16例患者行下肢动脉CTA,均形成不同程度的新生侧支血管.16例患者随访6 ～ 20个月(平均12.2个月)病情平稳;其中3例患者移植6个月后因患肢疼痛加重伴足趾溃疡形成,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,溃疡愈合.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.%Objective To investigate the efficiency of autologous peripheral blood stem cells transplantation (ABSCT) combined with Catheter-directed thrombolysis in rubulding the blood flow of patients with thromboangiitis obliterans (TAO) and reducing the amputation plane.Methods A retrospective analysis was performed in 16 patients (16 limbs) with TAO in the vascular surgery center of Yunnan province from Oct.2014 to June 2016 who took the treatment of ABSCT combined with Catheter-directed thrombolysis.Results Four weeks after the ABSCT,the scores of the legs pain and cold sensation of 16 patients (16 limbs) were better than those before.(P＜0.05) The variable temperate zones were lowered 2-10cm respectively.The condition of 2 patients with toes necrosis and ischemia of foot dorsum did not worsen.Three months after the ABSCT,the necrosis of one patient confined to toe area and the other to the middle of foot dorsum,both of which were dry gangrene.They took partial amputation and above the amputation plane the temperature and color of skin were normal.As to the rest 14 patients,the temperature of affected limbs increased from (26.68 ±0.51) ℃ to (31.45 ±0.49) ℃,the intermittent claudication distance from (80.59 ± 46.45) m to (332.45 ± 150.23) m and ABI from (0.42 ± 0.02) to (0.78 ± 0.04).The three indexes were all better than those before (P＜0.05).Nneonatal lateral vessels in different degree were found in 16 affected limbs of 16 patients by lower extremity CTA.16 patients were followed up for 6 to 20 months (mean 12.2 months) and the symptoms were stable.Due to leg pain aggravated and toe ulcers after 6 months,3 patients had ABSCT again.Three months after the operation,the symptoms were improved and toes ulcer was healed.Conclusiors Autologous peripheral blood stem cells transplantation combined with Catheter-directed thrombolysis in patients with thromboangiitis obliterans can promote the reconstruction of blood flow and reduce the amputation plane.