下肢静脉曲张伴溃疡患者的病因分析和疗效观察

Etiological analysis and curative effect observation of lower extremity varicose vein with ulcer

目的探讨下肢静脉曲张伴溃疡(C6级)患者的常见病因和治疗效果,为临床诊治提供参考。方法收集2020年7月至2021年12月深圳市第二人民医院收治的84例下肢静脉曲张伴溃疡患者的临床资料(共86条患肢),汇总患者的下肢静脉彩色多普勒超声和顺行造影检查数据,观察患肢的髂静脉压迫情况、深静脉瓣膜反流情况和穿通支静脉反流情况。对患者给予综合治疗,比较治疗前后患者的静脉临床严重程度评分(VCSS),观察治疗效果。结果下肢静脉曲张伴溃疡患者中,髂静脉压迫患肢62条(72.1%);深静脉瓣膜反流患肢47条(54.7%);穿通支静脉反流患肢64条(74.4%)。溃疡患者在术后3个月的随访期内,经过规律换药,溃疡均得到了愈合,随访期内溃疡未再发。所有患者的术后VCSS为(5.83±1.19)分,低于术前的(11.86±1.89)分,差异有统计学意义(P<0.05)。结论下肢静脉曲张伴溃疡患者中存在较高比例的髂静脉压迫、深静脉瓣膜反流、穿通支静脉反流,经过综合治疗后疗效显著。

Objective To investigate the common etiology and treatment effect of lower extremity varicose vein with ulcer(grade C6),and to provide a reference for clinical diagnosis and treatment.Method The clinical data of 84 patients with lower extremity varicose vein and ulcer admitted to Shenzhen Second People's Hospital from July 2020 to December 2021 were collected(86 affected extremities).The data of color Doppler ultrasound and anterograde venography of lower extremity veins were summarized to observe the iliac vein compression,deep venous valve reflux,and perforating branch reflux of the affected limb.The patients were given comprehensive treatment,and the venous clinical severity score(VCSS)of the patients before and after treatment was compared to evaluate the treatment effect.Result Among the 86 extremities in patients with lower extremity varicose veins and ulcers,62 extremities(72.1%)with iliac vein compression;47 extremities(54.7%)with deep venous valve reflux;64 extremities(74.4%)with perforating branch reflux.During the follow-up period lasting 3 months after the operation,the ulcers were healed after regular simple dressing changes,and the ulcers did not recur during this period.The postoperative VCSS score of all patients was(5.83±1.19),which was lower than the preoperative period(11.86±1.89),and the difference was statistically significant(P<0.05).Conclusion There is a high proportion of iliac vein compression,deep venous valve reflux,and perforating branch reflux in patients with lower extremities varicose vein and ulcer.After the comprehensive treatment,the curative effect is remarkable.