溃疡周围缝扎术治疗慢性阻塞性静脉功能不全并发的下肢溃疡

Periuleerous suturing for chronic deep venous thrombosis

目的探讨溃疡周围缝扎术在治疗严重阻塞性静脉功能不全并发下肢溃疡中的作用。方法临床收治32例阻塞性静脉功能不全并发溃疡患者随机分为两组，每组16例，对照组行常规物理治疗及药物治疗；缝扎组在常规物理治疗及药物治疗外加行溃疡周围缝扎术。记录观察治疗前后主要的临床和实验室指标，分析组间差异.结果治疗后局部反流交通支缝扎组（1．0±0．8）支，对照组（2．5±1．2）支，两组差异有统计学意义（P=0．001）。静脉血氧分压（39±7）mmHg，对照组（32±6）mmHg，两组差异有统计学意义（P=0．005），治疗后溃疡部位经皮氧分压缝扎组（71±12）mmHg，对照组（63±11）mmHg．两组差异有统计学意义（P=0．007）。缝扎组治疗后线粒体数量增多，局部浸润白细胞减少，粗面内质网形态正常，溃疡愈合时间（12±6）d，复发率12．5％，两组差异有统计学意义（P〈0．05）。结论周围缝扎术可减轻阻塞性静脉功能不全并发溃疡局部血流淤滞、炎性细胞浸润，改善组织营养状况及氧供，缩短溃疡愈合时间，对静脉阻塞性溃疡是一种简便、有效的治疗方法，与常规物理治疗联用可降低复发率。

Objective To investigate the effect of periulcerous suturing on the healing of skin ulceration in patients with chronic deep venous thrombosis. Methods Thirty-two patients were divided into two groups： control group treated with drugs and compression therapy; suturing group treated with drugs, compression therapy and skin suturing around the ulceration. The clinical data of these cases were retrospectively studied. Result In the suturing group, perforator veins （1.0 ± 0. 8） decreased, oxygen saturation of venous blood（39 ± 7） mm Hg and transcutaneous oxygen monitoring （ tePO2 ） （71 ± 12） mm Hg were elevated, the number of mitochondrion increased and white cell infiltration decreased, the figure of rough surfaced endoplasmic reticulum recovered, ulcer healing（ 12 ± 6） d quickened and recrudescence （ 12.5% ） lessened after treatment. All differences were statistically significant when compared with those in the control group （P 〈 0. 05 ）. Conclusion Suturing around the ulceration can lighten blood stagnation and inflammatory cell infiltration, improve dystrophy and oxygen supply of the tissue, shorten the period of ulcer healing. It is a simple, good therapeutic and economical method to cure ulcer and can decrease the recurrent rate with physiotherapy.