慢性下肢静脉性溃疡的临床治疗分析
| 作者: |
1尹孝亮,
2高涌,
2余朝文,
2聂中林,
2陈世远,
1郎德海
1 浙江省宁波市第二医院 血管外科，浙江 宁波 315010 2 蚌埠医学院第一附属医院 血管外科，安徽 蚌埠 233004 |
| 通讯: |
郎德海
Email: 13738868758@139.com |
| DOI: | 10.3978/.2018.06.014 |
| 基金: | 浙江省宁波市品牌学科发展基金资助项目（PPXK2018-01）；宁波市第二医院重点学科发展基金资助项目（2016-57）。 |
摘要
目的：探讨慢性下肢静脉性溃疡的临床治疗与疗效。
方法：回顾性分析 2014 年 3 月—2015 年 9 月收治的 48 例慢性下肢静脉性溃疡患者的临床资料，治疗上包括对基础病因的治疗、药物治疗、物理治疗、大隐静脉高位结扎加点式抽剥术、溃疡周围环扎术，对溃疡面积较大的（≥ 48.0 cm2）患者联合行游离皮瓣植皮术；溃疡愈合后长期穿医用弹力袜以促进静脉回流。
结果：经治疗溃疡面一期痊愈 12 例（25.0%），其中 5 例溃疡面积较大的植皮患者皮瓣全部存活；溃疡愈合面积达 70% 以上 27 例（56.3%），另外 9 例（18.7%）溃疡愈合面积亦达 50% 以上。平均住院时间 17.8 d，残余溃疡面门诊定期清洁换药。随访 3~12 个月，溃疡全部愈合，平均愈合时间 1.5 个月。
结论：在治疗原发基础病因的基础上，选择多种治疗手段相结合的复合式手术治疗慢性下肢静脉性溃疡效果满意，溃疡愈合快，复发率低。
关键词：
静脉曲张溃疡；静脉功能不全；下肢；综合疗法
方法：回顾性分析 2014 年 3 月—2015 年 9 月收治的 48 例慢性下肢静脉性溃疡患者的临床资料，治疗上包括对基础病因的治疗、药物治疗、物理治疗、大隐静脉高位结扎加点式抽剥术、溃疡周围环扎术，对溃疡面积较大的（≥ 48.0 cm2）患者联合行游离皮瓣植皮术；溃疡愈合后长期穿医用弹力袜以促进静脉回流。
结果：经治疗溃疡面一期痊愈 12 例（25.0%），其中 5 例溃疡面积较大的植皮患者皮瓣全部存活；溃疡愈合面积达 70% 以上 27 例（56.3%），另外 9 例（18.7%）溃疡愈合面积亦达 50% 以上。平均住院时间 17.8 d，残余溃疡面门诊定期清洁换药。随访 3~12 个月，溃疡全部愈合，平均愈合时间 1.5 个月。
结论：在治疗原发基础病因的基础上，选择多种治疗手段相结合的复合式手术治疗慢性下肢静脉性溃疡效果满意，溃疡愈合快，复发率低。
Analysis of clinical treatment for chronic venous lower-extremity ulcers
CorrespondingAuthor:LANG Dehai Email: 13738868758@139.com
Abstract
Objective: To investigate the clinical treatment of chronic venous lower-extremity ulcers and the treatment effi cacy.
Methods: Th e clinical data of 48 patients with chronic venous leg ulcers treated from March 2014 to September 2015 were retrospectively analyzed. The treatment modalities included the correction of the primary causal disease, drug therapy, physiotherapy, high ligation of the greater saphenous vein plus stripping, circular ligation around ulcers, combined free skin fl ap coverage for those with large ulcer area (≥48.0 cm2), and long-term use of elastic stockings to promote venous blood return aft er ulcer surface healing.
Results: After treatment, complete primary healing was achieved in 12 patients (25.0%), of whom, all the skin graft s survived in the 5 patients with large ulcer area; ulcer healing area of more than 70% was achieved in 27 patients (56.3%), and also reached 50% in the remaining 9 patients (18.7%). The average length of hospitalization was 17.8 d. Patients with residual leg ulcers received sterile dressings by regular clinic visits. The patients were followed up for 3 to 12 months and all ulcers were healed with an average healing time of 1.5 months.
Conclusion: Based on the correction of the primary causal disease, the integrated multi-therapy approach combined with surgical treatment for chronic venous leg ulcers has satisfactory effect for fast ulcer healing and low recurrence.
Keywords：
Varicose Ulcer; Venous Insufficiency; Lower Extremity; Combined Modality Therapy
Methods: Th e clinical data of 48 patients with chronic venous leg ulcers treated from March 2014 to September 2015 were retrospectively analyzed. The treatment modalities included the correction of the primary causal disease, drug therapy, physiotherapy, high ligation of the greater saphenous vein plus stripping, circular ligation around ulcers, combined free skin fl ap coverage for those with large ulcer area (≥48.0 cm2), and long-term use of elastic stockings to promote venous blood return aft er ulcer surface healing.
Results: After treatment, complete primary healing was achieved in 12 patients (25.0%), of whom, all the skin graft s survived in the 5 patients with large ulcer area; ulcer healing area of more than 70% was achieved in 27 patients (56.3%), and also reached 50% in the remaining 9 patients (18.7%). The average length of hospitalization was 17.8 d. Patients with residual leg ulcers received sterile dressings by regular clinic visits. The patients were followed up for 3 to 12 months and all ulcers were healed with an average healing time of 1.5 months.
Conclusion: Based on the correction of the primary causal disease, the integrated multi-therapy approach combined with surgical treatment for chronic venous leg ulcers has satisfactory effect for fast ulcer healing and low recurrence.