髂股静脉成形联合泡沫硬化剂栓塞术治疗下肢静脉性溃疡的早期疗效

Early clinical outcomes in the treatment of lower extremity venous ulcer by iliac and femoral venous plasty associated with bubble hardener embolization

目的比较单纯泡沫硬化剂与髂股静脉成形联合泡沫硬化剂栓塞术治疗髂股静脉狭窄或闭塞伴活动性下肢静脉溃疡的早期疗效。方法选择自2014年9月至2015年12月在滨州医学院附属医院住院的髂股静脉狭窄或闭塞伴活动性下肢静脉溃疡的患者96例,全部研究病例按照不同治疗方式随机分为试验组(髂股静脉开通成形+泡沫硬化剂栓塞术组)和对照组(单纯泡沫硬化剂栓塞术组)。比较两组患者术后第1、3、6个月溃疡愈合、复发、下肢肿痛及创面感染等并发症的发生率。结果术后第1个月两组患者的溃疡愈合率差异无统计学意义,术区肿痛、创面感染的发生率差异无统计学意义,两组患者均无溃疡复发。术后第3个月试验组患者的溃疡愈合率高于对照组(85.7%vs.68.1%,P<0.05),差异有统计学意义;术区肿痛、创面感染的发生率稍低于对照组(14.3%vs.25.5%,P>0.05,0 vs.6.38%,P>0.05),差异无统计学意义;对照组出现1例患者复发,试验组无患者复发,差异无统计学意义。术后第6个月试验组患者的溃疡愈合率显著高于对照组(93.9%vs.78.7%,P<0.05),差异有统计学意义;溃疡复发率显著低于对照组(2.0%vs.12.8%,P<0.05),差异有统计学意义;术区肿痛、创面感染的发生率显著低于对照组(4.1%vs.17.0%,P<0.05,2.0%vs.12.8%,P<0.05),差异有统计学意义。两组患者术中及随访期间均未出现死亡或失访病例,未发生下肢深静脉血栓形成、肺动脉栓塞等严重并发症。结论采用髂股静脉成形联合泡沫硬化剂栓塞术治疗髂股静脉狭窄或闭塞伴活动性下肢静脉溃疡的疗效确切,治愈率高、复发率低。

Objective To compare the early effect of pure bubble hardener embolization and iliac and femoral venous plasty associated with bubble hardener embolization in the treatment of active lower extremity venous ulcer which caused by iliac and femoral vein stenosis or occlusion. Methods Ninety six cases of patients with active lower extremity venous ulcer caused by iliac and femoral vein stenosis or occlusion in Binzhou Medical University Affiliated Hospital from September 2014 to December 2015 were selected. All the cases were divided into experimental group(iliac and femoral venous plasty associated with bubble hardener embolization) and the control group(pure bubble hardener embolization) according to different treatments. The occurrence rates of ulcer healing, recurrence, lower limb swelling and wound infection and other complications with postoperative 1, 3, 6 months in two groups of patients were compared. Results There was no statistically significant difference in two groups of patients with the healing rate of ulcer and the occurrence rate of lower limb swelling and wound infection in postoperative 1 month, and there was no ulcer recurrence in postoperative 1 month. Experimental group was higher than the control group with the healing rate of ulcer in postoperative 3 months(85.7% vs. 68.1%, P<0.05), and the difference was statistically significant. Experimental group was slightly lower than the control group with the occurrence rate of lower limb swelling and wound infection in postoperative 3 months(14.3% vs. 25.5%, P>0.05, 0 vs. 6.38%, P>0.05), and there was no statistically significant difference. There was one patient recurrent in the control group, there was no patient recurrent in experimental group, and there was no statistically significant difference. Experimental group was significantly higher than the control group with the healing rate of ulcer in postoperative six months(93.9% vs. 78.7%, P<0.05), and the difference was statistically significant. Experimental group was significantly lower than the control group with the recurrent rate of ulcer(2.0% vs. 12.8%, P<0.05) and the occurrence rate of lower limb swelling and wound infection(4.1% vs. 17.0%, P<0.05, 2.0 vs. 12.8%, P<0.05) in postoperative six months, and the difference was statistically significant. There were no case of death or lost during operation and follow-up. No serious complication such as deep venous thrombosis of lower extremity and pulmonary embolism occurred. Conclusion Iliac and femoral venous plasty associated with bubble hardener embolization shows curative effect, high cure rate, low recurrence rate in the treatment of active lower extremity venous ulcer which is caused by iliac and femoral vein stenosis or occlusion.