误诊为皮肤病的下肢慢性静脉功能不全的原因分析与防治

The Diagnosis and Treatment of Chronic Venous Incompetence(CVI) Misdiagnosed as Dermatosis

目的:探讨误诊为皮肤病的下肢慢性静脉功能不全的原因和诊治方法。方法:应用多种微创手术治疗2 0 0 0 - 0 5～2 0 0 4 - 0 5收治的误诊为皮肤病的下肢慢性静脉功能不全4 3例(患肢5 0条) ,该患肢5 0条经顺行性深静脉造影和彩色多普勒检查证实均同时存在浅静脉倒流和交通支静脉功能不全,患肢2 8条同时存在慢性静脉性溃疡,患肢14条同时存在重度深静脉返流。结果:5 0条患肢经多种微创手术治疗后皮肤色素沉着和湿疹样改变改善,脂质硬皮病好转,静脉曲张消失,2 8条静脉性溃疡肢体短期内愈合。随访3～4 7个月(平均2 8.5个月) ,无新生的溃疡,无静脉曲张复发。结论:下肢慢性静脉功能不全以皮肤色素沉着、湿疹样改变和脂质硬皮病以及慢性溃疡为主要临床表现时容易误诊,行静脉造影和彩色多普勒检查可以确诊,多种微创手术可以治疗下肢静脉功能不全,从而治愈皮肤病。

Objective:To explore the diagnosis and treatment of chronic venous incompetence(CVI) in patients misdiagnosed as dermatosis.Methods:Between May.2000 and May.2004, 43 patients(50 limbs) misdiagnosed as dermatosis with surperficial venous reflux and incompetent perforator had been checked by anterograde venography and color duplex.Twenty-eight limbs had active ulcers,and fourteen limbs had severe deep venous reflux.Results:The surgery obviously improved venous disability, varicose vein disappeared in all patients who had undergone minimally invasive operation; skin changs obviously improved;ulcers healed shortly in Twenty-eight limbs. There had been no ulcer recurrences and recurrent varicoses during follow-up (mean 28.5 months ,range 3~47 months).Conclusions:CVI could be easily misdiagnosed as dermatosis when it had no clinical features except skin changs (including:pigmentation,eczema,lipodermatosclerosis and active ulcer).We could give a correct diagnosis after the patient underwent anterograde venography and color duplex. Venous incompetence was improved and then dermatosis cured in all patients who had undergone minimally invasive operation.