糖尿病足の治療と予後決定因子について

Surgical Treatment and Prognostic Factors of the Diabetic Foot

　抄録：糖尿病足の手術症例58例85足の予後につき，その切断高位，術後生存期間，合併症について追跡調査を行い検討した．うち生死の確認が可能であった48例61足を対象とした．調査時点での生存者は26例で，22例は既に死亡していた．生存例の経過観察期間は平均3年10カ月，死亡例の術後生存期間は平均4年であった．最終手術または最終手術時の切断高位は，掻爬・皮膚移植が3足，足趾切断28足，足部切断4足，下腿切断21足で，大腿切断は5足であった．両側手術例は13例であった．切断高位と合併症との関係において，閉塞性動脈硬化症合併例では非合併例に比し，切断高位が高かった．また，虚血性心疾患や脳梗塞の合併例，透析例では術後生存期間が非合併例に比し短かった．切断後死亡率は，3年死亡率が下腿以上切断で57％，足部以下切断では33％であった．全身状態の不良な症例では特にその生活の質（以下QOL）をも考慮して切断高位を決定する必要がある．

　We evaluated prognostic factors in eighty-five feet of fifty-eight patients after surgical treatment for diabetic gangrene. Complications, amputation level, and prognosis were investigated in regard to forty-eight patients (sixty-one feet), twenty-six of whom were alive at the time of the final investigation and twenty-two of whom had died. Complications included peripheral arterial occlusive disease (PAD) in sixteen patients, cerebral infarction (CI) in twelve, and ischemic heart disease (IHD) in twelve.

　The average follow-up period of the survivors was 3 years ten months, and the average postoperative survival time of the patients who had died was 4 years. The final operations and/or amputation levels were：curettage or skin transplantations in 3 feet, toe amputations in twenty-eight feet, foot amputation in 4 feet, below knee (BK) amputation in twenty-one feet, and above knee (AK) amputation in 5 feet.

　The correlations between the amputation levels and complications showed that the amputation level in the patients with PAD was higher than in the patients without PAD. The postoperative survival time of the patients with IHD and/or CI was shorter than that of the patients without IHD and/or CI.

　The 3-year postoperative mortality rate of the patients in whom the amputation was performed at the BK or higher level was 57％, versus 33％among the patients in whom the amputation was performed at the foot or the toe level.

　These results suggest that QOL should be taken into consideration when deciding on the amputation level in patients whose general condition is poor.