高龄下肢静脉淤积性溃疡的激光微创综合治疗

Minitrouma Laser Treatment of Leg Venous Ulceration of Elder Patients

目的总结激光微创治疗高龄下肢静脉瘀积性溃疡的临床经验。方法回顾性分析2006年1月至2016年6月,高龄下肢静脉淤积性溃疡患者42例的临床资料,年龄70~89岁(平均76岁),采用激光光凝溃疡周围的交通支静脉、皮瓣下穿支静脉,术后患肢加压包扎、溃疡局部清洁换药,促进愈合。术后6个月内每月记录下肢溃疡情况以及静脉曲张消失情况,术后10、12个月及术后1、2年定期随访,物理检查有无静脉曲张,溃疡愈合情况,彩色多普勒检查光凝后的血管有无再通、有无血栓,尤其是有无深静脉血栓。结果 42例患者的手术时间45~100 min,平均65 min。失血10~30 ml,平均14 ml。术后1个月下肢曲张浅静脉均消失,溃疡均明显好转。术后3个月溃疡完全愈合32例,治愈率62.2%;术后6个月溃疡完全愈合37例,治愈率88.1%;手术后1年全部愈合;术后随访2年以上者32例,均治愈,无溃疡复发。结论血管内激光光凝可用于下肢静脉瘀积性溃疡的治疗,是一种较好的微创治疗方法。

Objective To summary the experience in treating leg venous ulcer of elder patients. Methods The data of 42 patients aged from 70 to 89 （76 years old on average） and diagnosed venous ulcer of lower extremity over the period from Jan. 2006 to Jun. 2016 was collected and analyzed. All these patients were given endovascular ablation of varicose vein and reflux traffic branch peri-ulceration. Pressure dressing was performed after the operation. Results The operative time was 45-100 rain （ mean 65 min） and the blood loss 10-30 ml （ mean 14 ml）. The cure rates were 62. 2%, 88. 1% and 100% respectively on the 3rd month, 6th month and 12th month after the operation. No ulcer recurrence was found in 32 patients in 2 years following the operation. Conclusions Being an ideal minitrauma operation, endovascular laser ablation can be used to treat venous ulceration of elder patients.