下肢静脉性溃疡的综合性手术治疗

The synthetic surgical treatment of venous ulcer in the lower limb

目的探讨下肢静脉性溃疡综合性手术治疗的价值。方法总结38例(43条肢体)下肢静脉曲张合并静脉性溃疡患者手术治疗的临床资料。全部患者术前都行顺行性深静脉造影。所有患肢均行浅静脉手术和溃疡周围曲张浅静脉缝扎术,其中8条患肢加行深静脉瓣膜修补术,17条患肢加行腔镜深筋膜下交通静脉结扎术即SEPS,9条患肢加行深静脉瓣膜修补术和SEPS。结果术后所有患者的症状消失,溃疡愈合,小腿皮肤的湿疹或色素沉着明显减轻。术后6个月随访,有6条患肢出现溃疡复发,加行SEPS治疗后溃疡愈合。术后1～2年随访,均无静脉性溃疡复发。结论下肢静脉性溃疡是深、浅静脉和交通静脉功能不全共同作用的结果。在治疗下肢静脉性溃疡时,应同时纠正每个静脉系统的功能不全,尤其是交通静脉功能不全。

Objective To study the value of the synthetic surgical treatment of venous ulcer in the lower limb. Methods From June 2002 to August 2004, clinic data of operative treatment for 38 patients （43 limbs） with varicose vein in the lower limb accompanying by venous ulceration were retrospectively analyzed. An hy was performed for all of patients before operation. Superficial vein operation and varicose veins suture around ulcer were undergone in all of sick limbs. At the same time, deep vein valve repair （DVVR） was done in 8 of them, subfascial endoscopic perforator surgery （SEPS） in 17 of them, DVVR and SEPS in 9 of them. Results The symptoms were disappeared and the ulcers were healed in all cases after operation.The eczema or pigmentation of the lower limb, s skin was relieved remarkably. The ulcer of 6 limbs was recurrence on 6 months after operation. These ulcers were healed by SEPS treatment.No ulcer recurrence was found within 1-2 years after operation. Conclusion Venous ulcer of lower limbs results from insufficiency of deep, superficial and perforating venous systems. When the venous ulcer is treated, the insufficiency of every venous system must be corrected at the same time, especially in the insufficiency of perforating venous system.