泡沫硬化剂注射病理性穿通静脉治疗下肢静脉性溃疡的疗效观察

Observation of curative effect of foam sclerotherapy for pathological perforator veins in the treatment of variceal ulcer of lower extremities

目的探讨超声引导下泡沫硬化剂注射病理性穿通静脉治疗下肢静脉性溃疡(VULE)的临床疗效。方法横断面研究。纳入2017年1月—2021年1月蚌埠医科大学第一附属医院60例(65侧)确诊为病理性穿通静脉引起的VULE患者。其中男38例、女22例,年龄46~77(56.3±11.4)岁,临床-病因-解剖-病理生理(CEAP)分级均为C6期。患者采用超声引导下泡沫硬化剂注射病理性穿通静脉治疗。观察手术时间、术后住院时间、溃疡创面愈合情况、穿通静脉反流情况,以及局部硬结形成、皮肤坏死、深静脉血栓形成、肺动脉栓塞、脑卒中、一过性视觉障碍等术后并发症发生情况。结果60例患者手术均顺利完成,未出现硬化剂渗漏、出血、软组织肿胀等情况。手术时间23.0~80.0(46.6±12.2)min,术后住院时间1.0~10.0(5.6±1.7)d。2例患者术后第7天局部硬结形成,予相应处理后痊愈。60例患者均获随访,随访时间6~12(10.8±2.7)个月。随访期间,2例患者术后2个月左右复发,出现微小溃疡,超声检查见原闭合穿通静脉部分再通,再次行超声定位下局部麻醉注入泡沫硬化剂后,患者溃疡痊愈,随访3个月无再次复发。60例患者65侧患肢溃疡面均于1~3个月愈合,复查超声原溃疡创面周围均无病理性穿通静脉反流。患者患侧下肢瘙痒、疼痛、色素沉着等症状均明显好转,无皮肤坏死、深静脉血栓形成、肺动脉栓塞、脑卒中、一过性视觉障碍等并发症。结论超声引导下泡沫硬化剂注射病理性穿通静脉治疗VULE安全有效,操作方便,术后复发者可反复应用,值得临床推广应用。

Objective This study aimed to explore the curative effect of foam sclerotherapy for pathological perforator veins in the treatment of variceal ulcer of lower extremities(VULE)under ultrasound guidance.Methods A cross-sectional study was conducted.Sixty patients(65 sides)with VULE caused by pathological perforator veins who were admitted to the First Affiliated Hospital of Bengbu Medical University from January 2017 to January 2021 were included in this study.Among them,38 were males and 22 were females,with an average age of 46−77(56.3±11.4)years.The clinical-etiological-anatomical-pathological-physiological classification was grade C6.The patients were treated with foam sclerotherapy for pathological perforator veins under ultrasound guidance.The operation time,postoperative hospital stay,ulcer healing,perforator vein reflux,and postoperative complications(such as local induration formation,skin necrosis,deep vein thrombosis,pulmonary embolism,stroke,and transient visual impairment)were observed.Results All surgeries of the 60 patients were successfully completed without any complications such as sclerosant leakage,bleeding,or soft tissue swelling.The operation time was 23.0−80.0(46.6±12.2)min,and the postoperative hospital stay was 1.0−10.0(5.6±1.7)days.Two patients developed local induration on the 7th day after surgery,but they recovered after appropriate treatment.All 60 patients were followed up for 6−12(10.8±2.7)months.During the follow-up period,two patients experienced recurrence of minor ulcers around 2 months after surgery,with ultrasound examination revealing partial reperfusion of the previously closed perforator veins.They were treated with foam sclerotherapy under ultrasound guidance,and their ulcers healed without further recurrence after 3 months of follow-up.The ulcers on the affected limbs of all 65 sides in the 60 patients healed within 1−3 months,and follow-up ultrasound examinations showed no pathological perforator vein reflux around the original ulcer site.During the follow-up period,symptoms such as itching,pain,and pigmentation on the affected lower limbs significantly improved,and there were no complications such as skin necrosis,deep vein thrombosis,pulmonary embolism,stroke,or transient visual impairment.Conclusion Using foam sclerotherapy under ultrasound guidance to treat pathological perforator veins in VULE is safe and effective.It features easy operation and the ability to be repeatedly used in case of postoperative recurrence.Therefore,it is worth promoting and applying clinically.