激光闭合穿通支静脉治疗下肢静脉溃疡

Laser ablation of perforator in lower limb venous ulcer

目的 :探讨激光闭合穿通支静脉在下肢静脉性溃疡治疗中的作用。方法 :以2014年1月至2015年12月收治的28例下肢静脉溃疡(28条肢体)。所有病人均行CT静脉成像定位溃疡处穿通支静脉。14例行大(小)隐静脉高位结扎+穿通支静脉激光闭合术(激光组),另14例行大(小)隐静脉高位结扎+穿通支静脉结扎术(对照组)。术后均以弹力袜加压并定期处理溃疡创面,随访2年。结果:两组病人一般情况无统计学差异。术前溃疡病程和溃疡面积均无统计学差异。激光组术后1周溃疡面积缩小值明显大于常规组(P<0.05),1个月和2个月的溃疡面积缩小值无差异。对照组有6例发生切口愈合不良,高达42.9%,而激光组仅1例出现局部灼伤。两组间有明显统计学差异(P<0.01)。2个月内溃疡愈合的比例在两组间无差异,均为12例(85.7%)。两组1年内溃疡复发率亦无统计学差异(P>0.05),1~2年内均无复发。结论 :在大(小)隐静脉结扎的基础上,激光闭合穿通支静脉可有效促进溃疡愈合。

Objective To evaluate the safety and efficacy of laser ablation in the treatment of perforating veins from lower limb venous ulcer. Methods A total of 28 cases with chronic venous ulcer admitted between January 2014 to December 2015 were concluded in this study. Localization and mark of the perforating veins were done with CTV. High ligation was performed in all cases with great or small saphenous vein. Then half of them underwent the procedure of laser ablation to perforating venous in 1d cases as laser group. The other 14 cases were treated by ligation of perforating veins after high ligation of great or small saphenous veins as control group. Compression with local therapy of ulcer postoperatively and 2 year of follow-up were given for all the cases. Results There was no difference of general information in 2 groups. The ulcer area and history of venous ulcer were similar in both groups before operation. The decrease in ulcer area of postoperative first week in laser group was much more than that in control group （P〈0.05）. However the decrease in ulcer area was similar in postoperative 1 month and 2 month between 2 groups. Six cases （42.9%） in control group and one in laser group had wound complication（P〈0.01）. Complete healing of ulcer within 2 months was obtained in 12（85.7%） cases both group. The recurrence rate within 1 year was similar between 2 groups （P〉0.05） and no recurrence was present between 1 to 2 year in 2 groups. Conclusions Laser ablation of perforating vein can effectively promote the healing of ulcer after high ligation of great or small saphenous vein.