老年下肢静脉性皮肤溃疡1例

A case of venous skin ulcer of lower limbs

报道老年下肢静脉性皮肤溃疡1例。患者女,84岁,因双下肢溃疡伴疼痛1月就诊。皮肤科检查:右足背红肿,见11 cm×4 cm大小溃疡,有脓苔及黑色结痂,内踝见20 cm×5 cm大小溃疡,左小腿散在结痂面。D-二聚体4.81 mg/L。皮损组织病理示:表皮缺失,溃疡面坏死、渗出,毛细血管周围大量炎性细胞,肉芽肿形成。下肢静脉彩超:右小腿见数条肌腱静脉增宽,最宽处约4.8 mm,未见明显血流信息。诊断:右下肢静脉性皮肤溃疡。予低分子量肝素钠针、血栓通冻干粉针抗凝治疗14天及对症处理,出院时溃疡好转但血栓未通;出院后内服中药活血理气汤3周,溃疡恢复,下肢静脉彩超血栓消失。

An 84-year-old female patient presented with ulcer and pain on both lower limbs.Physical examination indicated that the right foot dorsum was red and swollen,with an ulcer which was 11 cm×4 cm size,and covered with purulent coating and black scab.There was also a 20 cm×5 cm size ulcer on the medial malleolus,and scattered scab on the left leg.The serum concentration of D-dimer was 4.81 mg/L.Pathological examination showed that epidermis loss,ulcer surface necrosis,exudation,a large number of inflammatory cells around capillaries and granuloma formation.Color doppler ultrasound of lower extremity vein indicated that there were several widened tendon veins in the right leg which were about 4.8 mm wide,without obvious blood flow information.The patient was diagnosed as venous skin ulcer of right lower limb.After 14 days of anticoagulant therapy with low molecular weight heparin sodium and Xueshuantong lyophilized powder needle as well as symptomatic treatment,the ulcer was improved but the thrombus was not unblocked at discharge.After 3 weeks of oral administration of Huoxue Liqi decoction at home,the ulcer recovered and the venous thrombosis disappeared.