48例下肢静脉性溃疡的微创治疗  

Minimally invasive treatment for 48 patients with lower extremities venous ulcers

作　　者：赵为国[1] 吴良平[1] 戴晓江[1] 王俊[1] 

机构地区：[1]广州军区广州总医院普通外科,510010

出　　处：《中国医师进修杂志》2010年第2期18-20,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨下肢静脉性溃疡的微创治疗效果。方法对48例（56侧）下肢静脉性溃疡通过静脉造影检查明确引起溃疡的原发病变，根据患肢血流动力学异常的种类和程度对8例（8侧）行大隐静脉高位结扎联合静脉腔内激光治疗（EVLT）＋内镜深筋膜下交通静脉离断术（SEPS）＋股浅静脉瓣膜戴戒术；24例（28侧）行大隐静脉高位结扎＋EvLT＋SEPS；16例（20侧）行大隐静脉高位结扎＋EVLT。溃疡均行周缘环行缝扎。结果术后56侧患肢浅静脉曲张均消失，皮肤色素沉着、湿疹样改变均明显减轻；51侧小腿酸胀沉重感、疼痛、水肿14—18d消失，溃疡16～48d愈合。随访4～46个月，平均（24．8±6．5）个月，4侧（7．1％）肢体溃疡复发。结论纠正浅静脉、交通支静脉、深静脉功能不全和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法，EvLT和SEPS操作简便、微创、安全，联合股浅静脉瓣膜戴戒术可以有效地减少下肢静脉洼溃疡的复发。Objective To study the efficacy of minimally invasive treatment for lower extremities venous ulcers. Methods A total of 48 patients with lower extremities venous ulcers （56 limbs） were examined with venography to identify the primary lesion that resulted ulcer. According to the type and degree of hemodynamic abnormality, high ligation of the great saphenous vein combined with endovenous laser treatment, subfascial endoscopic perforator surgery; and external banding valvuloplasty of the superficial femoral vein were done in 8 cases （8 limbs）, high hgation of the great saphenous vein combined with endovenous laser treatment and subfascial endoscopic perforator surgery were carried out in 24 cases （28 limbs）,and high ligation of the great saphenous vein combined with endovenous laser treatment was performed on 16 cases （20 limbs）. In all cases,the ulcers were circumferentially ligated at the same time. Results After the operations, superficial varicosis, pigmentations, and eczematous relieved remarkably in the 56 limbs. In 51 limbs, heavy feeling, ache, and edema disappeared 14-18 days after operation. The ulcers of the 56 limbs healed 16-48 days after operation. During 4 to 46 months follow up, ulcers recurred in 4 limbs （7.1% ）. Conclusions It is effective to correct the incompetence of the superficial, perforating, and deep veins and manage the surface of ulcers for lower extremities venous ulcers. Endovenous laser treatment and subfascial endoscopic perforator surgery are easily performing, minimally invasive, and safe operations. The recurrence of leg ulcers can be reduced by external banding valvuloplasty of the superficial femoral vein.

关 键 词：静脉曲张溃疡 外科手术 微创性 

分 类 号：R632.1[医药卫生—外科学] R651.15[医药卫生—临床医学]