外科手术联合腔内技术治疗下肢静脉性溃疡的疗效分析

doi:10.16139/j.1007-9610.2020.04.014

摘要/Abstract

摘要：

目的：探讨外科手术联合血管腔内技术治疗下肢静脉性溃疡的临床疗效。方法：回顾分析深圳大学第一附属医院（深圳市第二人民医院）血管外科2016年1月至2019年12月下肢静脉性溃疡病人,探讨外科手术联合腔内技术治疗溃疡的临床疗效。结果：127例下肢溃疡病人,大隐静脉主干激光闭合22例、主干剥脱84例;支架置入30例,共35枚。除1例溃疡尚未愈合,其余病人经外科手术联合腔内治疗后均康复出院,随访无溃疡复发。结论：外科手术联合腔内技术有利于缩短下肢静脉性溃疡愈合时间。

关键词: 溃疡, 静脉曲张, 外科手术, 支架

Abstract:

Objective To investigate the clinical effect of combined surgical and endovascular approach in treatment of lower limb venous ulcer. Methods Patients with lower limb venous ulcer in the First Affiliated Hospital of Shenzhen University(Shenzhen Second People's Hospital) from January 2016 to December 2019 were retrospectively analyzed, and the clinical efficacy of combined surgical and endovascular approach was explored. Results A total of 127 patients with lower limb ulcer were enrolled including 22 cases with laser therapy for greater saphenous vein, 84 cases with stripping therapy and 30 cases (35 stents) with implantation of stent. The patients recovered using combined surgical and endovascular approach, and all but one patient discharged from hospital. One patient was without heal of ulcer. There was no ulcer recurrence shown by follow-up. Conclusions Treatment with combined surgical and endovascular approach could shorten the healing time of lower limb venous ulcer.

Key words: Ulcer, Varicose vein, Surgery, Stent

中图分类号:

R543.6

李涛, 杨静, 杨红伟, 林环, 王祖辉, 郭娟娟, 朱国献. 外科手术联合腔内技术治疗下肢静脉性溃疡的疗效分析[J]. 外科理论与实践, 2020, 25(04): 336-340.

LI Tao, YANG Jing, YANG Hongwei, LIN Huan, WANG Zuhui, GUO Juanjuan, ZHU Guoxian. Effect of combined surgical and endovascular approach to lower limb venous ulcer[J]. Journal of Surgery Concepts & Practice, 2020, 25(04): 336-340.

图/表 6

图1

图2

图3

图4

表1

表2

参考文献 17

[1]	中华医学会外科学分会血管外科学组. 慢性下肢静脉疾病诊断与治疗中国专家共识[J]. 中国血管外科杂志(电子版), 2014, 6(3):143-151.
[2]	Fukaya E, Flores AM, Lindholm D, et al. Clinical and genetic determinants of varicose veins[J]. Circulation, 2018, 138(25):2869-2880. doi: 10.1161/CIRCULATIONAHA.118.035584 pmid: 30566020
[3]	Mousa AY, Broce M, Yacoub M. Validation of venous duplex ultrasound imaging in determining iliac vein stenosis after standard treatment of active chronic venous ulcers[J]. J Vasc Surg Venous Lymphat Disord, 2016, 4(3):307-312.
[4]	Liu P, Peng J, Zheng L, et al. Application of computed tomography venography in the diagnosis and severity assessment of iliac vein compression syndrome: A retrospective study[J]. Medicine(Baltimore), 2018, 97(34):e12002.
[5]	朱国献, 谭毅华, 李涛. 下肢静脉曲张手术治疗的经验探讨[J/CD]. 中华普通外科学文献(电子版), 2016, 10(2):91-92.
[6]	Hamann SAS, Timmer-de Mik L, Fritschy WM, et al. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency blation for the treatment of great saphenous varicose veins[J]. Br J Surg, 2019, 106(8):998-1004. doi: 10.1002/bjs.11187 pmid: 31095724
[7]	Mousa AY, Broce M, Yacoub M. Iliac vein interrogation augments venous ulcer healing in patients who have failed standard compression therapy along with patholo-gical venous closure[J]. Ann Vasc Surg, 2016, 34:144-151. doi: 10.1016/j.avsg.2015.11.036 URL
[8]	Wen-da W, Yu Z, Yue-Xin C. Stenting for chronic obstructive venous disease: A current comprehensive meta-analysis and systematic review[J]. Phlebology, 2016, 31(6):376-389. doi: 10.1177/0268355515596474 pmid: 26205370
[9]	韩丽丽. 下肢静脉曲张伴溃疡患者的护理研究[J]. 中国现代药物应用, 2019, 13(18):208-210.
[10]	李丹, 刘黎莉. 下肢静脉溃疡伤口护理评估及处理[J]. 心血管外科杂志(电子版), 2020, 9(1):261-262.
[11]	梁洁萍. 敷料及护理干预对下肢静脉曲张伴慢性溃疡患者的影响分析[J]. 心血管外科杂志(电子版), 2019, 8(2):170-171.
[12]	Gohel MS, Heatley F, Liu X, et al. A randomized trial of early endovenous ablation in venous ulceration[J]. N Engl J Med, 2018, 378(22):2105-2114. doi: 10.1056/NEJMoa1801214 URL
[13]	Phillips MN, Dijkstra ML, Khin NY, et al. Endovenous valve transfer for chronic deep venous insufficiency[J]. Eur J Vasc Endovasc Surg, 2013, 46(3):360-365. doi: 10.1016/j.ejvs.2013.05.013 URL
[14]	中华医学会外科学分会血管外科学组, 中国医师协会血管外科医师分会, 中国医疗保健国际交流促进会血管外科分会, 等. 中国慢性静脉疾病诊断与治疗指南[J]. 中华医学杂志, 2019, 99(39):3047-3061.
[15]	George R, Verma H, Ram B, et al. The effect of deep venous stenting on healing of lower limb venous ulcers[J]. Eur J Vasc Endovasc Surg, 2014, 48(3):330-336. doi: 10.1016/j.ejvs.2014.04.031 URL
[16]	Lawrence PF, Hager ES, Harlander-Locke MP, et al. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(4):601-609. doi: S2213-333X(19)30534-7 pmid: 32089497
[17]	李涛, 朱国献, 杨红伟, 等. 下肢静脉曲张伴溃疡的病因分析及治疗[J]. 中国血管外科杂志(电子版), 2020, 12(1):47-50.

支架型号	髂静脉受压	静脉曲张合并髂静脉受压	血栓形成后综合征	下腔静脉狭窄	合计
WALLSTENT（枚）	3	13	4	3	23
E-LUMINEXX（枚）	2	7	3	0	12
合计（枚）	5(4例)	20(19例)	7(4例)	3(3例)	35(30例)