压力配合泡沫硬化剂治疗伴交通支静脉功能不全的下肢静脉性溃疡的临床疗效

Pressure treatment combined foam sclerotherapy in venous leg ulcer complicated with incompetent perforator veins

目的探讨单纯压力治疗、压力配合泡沫硬化剂(FS)、压力配合腔内激光治疗(EVLT)对伴交通支静脉功能不全(IPV)的下肢静脉性溃疡(VLU)患者的临床疗效。方法收集2017年1月至2020年3月北京中医药大学东直门医院收治的90例伴有IPV的VLU患者临床资料,根据治疗方式的不同将患者分为单纯压力治疗组(n=27)、压力配合FS组(n=31)、压力配合EVLT组(n=32)。观察3组患者的创面愈合时间及随访1年内的溃疡再发情况。观察压力配合FS组和压力配合EVLT组患者局部红肿、疼痛、麻木等术后并发症情况。结果3组患者的溃疡愈合时间比较,差异有统计学意义(P<0.05)。压力配合FS组与压力配合EVLT组患者溃疡的愈合时间均短于单纯压力治疗组患者,差异均有统计学意义(P<0.05)。溃疡愈合后,对患者随访1年,从溃疡愈合后的第5个月开始,单纯压力治疗组患者的溃疡复发率明显高于压力配合FS组和压力配合EVLT组患者(P<0.05)。压力配合FS组患者术后并发症的发生率为25.8%(8/31),低于压力配合EVLT组患者的53.1%(17/32),差异有统计学意义(P<0.05)。结论对于伴有IPV的VLU患者,处理IPV至关重要,且泡沫硬化剂治疗的术后并发症少于激光治疗。

Objective To explore the clinical efficacy of pressure treatment,pressure treatment+foam sclerotherapy(FS)and pressure treatment+endovenous laser treatment(EVLT)in patients with venous leg ulcer(VLU)complicated with incompetent perforator vein(IPV).Method Clinical data of 90 patients with VLU+IPV admitted in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2017 to March 2020 was collected,and the patients were divided into the pressure treatment group(n=27),pressure treatment+FS group(n=31),pressure treatment+EVLT group(n=32)based on different treatment methods.The wound healing time of patients and ulcer recurrence within 1-year follow-up in three groups were observed;the postoperative complications(such as local red and swelling,pain,numbness)in the pressure treatment+FS group and pressure treatment+EVLT group were observed.Results There was significant difference for the wound healing time among three groups(P<0.05),with shorter healing time in pressure treatment+FS group and pressure treatment+EVLT group than that in the pressure group(P<0.05).The ulcer recurrent rate in the pressure treatment group was higher than that in the pressure treatment+FS group and pressure treatment+EVLT group from the fifth month after healing of ulcer during 1-year follow-up(P<0.05).The incidence of complications is lower in the pressure treatment+FS group than that in the pressure treatment+EVLT group[25.8%(8/31)vs 53.1%(17/32),P<0.05].Conclusion For VLU patients with IPV,it is essential to treat IPV,and the postoperative complications of foam sclerotherapy are less than laser treatment.