下肢静脉性溃疡的外科治疗

Surgical Treatment of Lower Extremity Venous Ulceration

目的 探讨下肢静脉性溃疡的有效疗法。方法 回顾分析 79例 85条患肢 94个静脉性溃疡的临床资料。通过血管造影和彩超检查明确引起溃疡的原发疾病。所有患者术前都经过严格的保守治疗 ,根据患肢血流动力学异常的种类和程度采用不同的手术方式对 67条患肢的深静脉进行重建 ,85条患肢均行浅静脉及交通支静脉手术。并对 5 9个直径超过 2cm的溃疡行自体中厚皮片移植术。结果 94个溃疡均于 45d内愈合。经随访 3例溃疡复发 ,复发者均为未进行深静脉重建者。结论 纠正深静脉、浅静脉、交通支静脉功能不全和重视溃疡面抗炎湿敷治疗是治疗下肢静脉性溃疡的有效疗法。联合溃疡区植皮可加速溃疡的愈合。

Objective To evaluate the effective treatment of venous ulceration of the lower extremity. Methods Retrospective study of 85 limbs (79 cases) with 94 venous ulcerations. All subjects were examined with venography and color Doppler Ultrasonography US and performed with strict conservative therapy before operation. Deep-vein reconstruction were performed on 67 limbs according to the type and degree of abnormality of hemodynamics in lower extremity. All limbs were performed with superficial-vein and perforator-vein operation. We even completed intermediate splitthickness skin graft transplantation on 59 ulcerations with more than 2cm in diameters. Results 94 ulcerations had healed within 45 days and 3 cases among those who were not performed with deep-vein reconstruction recurred. Conclusion The correction of deep vein, superficial vein and perforator vein and wet dressing and anti-inflammation on the surface of ulcerations are the effective methods, if associated with ulceration-area skingrafting can accelerate the healing of ulcerations.