微创处理溃疡周围相关静脉在下肢静脉性溃疡治疗中的应用
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摘要
目的观察下肢静脉性溃疡周围相关静脉及其下方静脉团的分布特点,探讨微创手术处理下肢性溃疡周围相关静脉对溃疡创面愈合的影响。方法回顾性分析2013年8月至2018年12月铜陵市人民医院收治的57例慢性下肢静脉功能不全合并下肢静脉性溃疡患者的临床资料,根据治疗方法的不同分为微创手术组(28例)和保守治疗组(29例)。分别统计2组患者溃疡周围相关静脉的数量及下方静脉团的存在情况,比较微创手术治疗与保守治疗的效果。结果溃疡周围相关静脉数量及溃疡下方静脉团的存在情况与溃疡直径呈明显正相关。当溃疡直径小于2 cm时,2组患者溃疡愈合时间差异无统计学意义(P> 0. 05);当溃疡直径大于等于2 cm时,微创手术组患者溃疡创面的愈合时间短于保守治疗组,差异有统计学意义(P <0. 05)。结论对于合并下肢静脉性溃疡的慢性静脉功能不全的患者,处理大隐静脉主干的同时微创处理下肢静脉性溃疡周围相关静脉能加速溃疡创面愈合。
Objective The aim of this study is to observe the distribution characteristics of the related veins around venous ulcerations and the vein clusters below ulcerations of lower limb,and the effect of minimally invasive surgical treatment on ulcer healing of lower extremities with venous ulcerations was discussed. Methods Data of 57 cases with venous ulcerations of lower limb treated in the people's hospital of Tongling city from August 2013 to December 2018 were retrospectively analyzed. They were divided into minimally invasive surgery group( 28 cases) and conservative treatment group( 29 cases) according to the diameter of the ulcer. The number of related veins around the ulcer and the presence of the vein clusters were counted separately. The efficacy of minimally invasive surgery and conservative treatment was compared. Results The number of related veins around the ulcer and the presence of vein clusters under the ulcer showed a significantly positive correlation with the diameter of the ulcer. There was no significant difference in healing time of the lesion between two groups when the diameter of the lesion was less than 2 cm( P > 0. 05). When the diameter of the lesion was equal or more than 2 cm,the healing time of the lesion in the minimally invasive surgery group was shorter than that in the conservative treatment group,the difference was significant( P < 0. 05).Conclusion For patients with venous ulcerations complicated by chronic venous insufficiency of the lower extremities,treating the trunk of great saphenous vein and minimally invasive treatment of related veins around lower extremity ulcer can accelerate the healing of venous ulcerations.
Objective The aim of this study is to observe the distribution characteristics of the related veins around venous ulcerations and the vein clusters below ulcerations of lower limb,and the effect of minimally invasive surgical treatment on ulcer healing of lower extremities with venous ulcerations was discussed. Methods Data of 57 cases with venous ulcerations of lower limb treated in the people's hospital of Tongling city from August 2013 to December 2018 were retrospectively analyzed. They were divided into minimally invasive surgery group( 28 cases) and conservative treatment group( 29 cases) according to the diameter of the ulcer. The number of related veins around the ulcer and the presence of the vein clusters were counted separately. The efficacy of minimally invasive surgery and conservative treatment was compared. Results The number of related veins around the ulcer and the presence of vein clusters under the ulcer showed a significantly positive correlation with the diameter of the ulcer. There was no significant difference in healing time of the lesion between two groups when the diameter of the lesion was less than 2 cm( P > 0. 05). When the diameter of the lesion was equal or more than 2 cm,the healing time of the lesion in the minimally invasive surgery group was shorter than that in the conservative treatment group,the difference was significant( P < 0. 05).Conclusion For patients with venous ulcerations complicated by chronic venous insufficiency of the lower extremities,treating the trunk of great saphenous vein and minimally invasive treatment of related veins around lower extremity ulcer can accelerate the healing of venous ulcerations.
引文
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[12]Faler BJ,Macsata RA,Plummer D,et al. Transforming growth factorbeta and wound healing[J]. Perspect Vasc Surg Endovasc Ther,2006,18(1):55-62.
[13]Chen JH,Stoeber K,Kingsbury S,et al. Loss of proliferative capacity and induction of senescence in oxidatively stressed human fibroblasts[J]. J Biol Chem,2004,279(47):49439-49446. doi:10. 1074/jbc.M409153200.
[14]赵渝,王学虎.下肢静脉性溃疡的诊治进展[J].临床外科杂志,2016,24(8):589-591.
[15]张冠一,孟庆义.腔内激光联合泡沫硬化剂治疗下肢静脉性溃疡的疗效分析[J].中国血管外科杂志(电子版),2018,12(10):275-278. doi:10. 3969/j. issn. 1674-7429. 2018. 04. 011.
[16]侯乐伟,邓国瑜,梅志军,等.筋膜下经内镜穿通静脉离断术治疗下肢静脉性溃疡10年临床随访[J].现代生物医学进展,2014,14(20):3896-3897. doi:10. 13241/j. cnki. pmb. 2014. 20. 025.
[2] Cowan T. Strategies for improving outcomes in venous leg ulcer care[J]. J Wound Care,2018,27(7):456-457. doi:10. 12968/jowc.2018. 27. 7. 456.
[3]梅家才,郑月宏,王晓天,等.实用静脉曲张治疗学[M].南京:东南大学出版社,2017:250-257.
[4]Trent JT,Falabella A,Eaglstein WH,et al. Venous ulcers:pathophysiology and treatment options[J]. Ostomy Wound Manage,2005,51:38-54.
[5]Jull AB,Arroll B,Parag V,et al. Pentoxifylline for treating venous leg ulcers[J]. Cochrane Database Syst Rev,2012,12:CD001733. doi:10.1002/14651858. CD001733.
[6]Senet P,Blas-Chatelain C,Levy P,et al. Factors predictive of leg-ulcer healing in sickle cell disease:a multicenter,prospective cohort study[J]. Br J Dermatol,2017,177(1):206-211. doi:10. 1111/bjd.15241.
[7]马震寰,杨镛,杨国凯,等. Trivex静脉旋切系统在静脉性溃疡治疗中的应用[J].中国医药导报,2008,5(8):94-119. doi:10. 3969/j. issn. 1673-7210. 2008. 08. 066.
[8]Ozdogu H,Yeral M,Boga C. An unusual giant leg ulcer as a rare presentation of sweet's syndrome in a patient with hairy cell leukemia successfully managed by splenectomy[J]. Turk J Haematol,2017,34(3):270-271. doi:10. 4274/tjh. 2016. 0416.
[9]王深明,姚陈.慢性静脉性溃疡的研究现状与诊治策略[J].中国医学科学院学报,2007,29(1):5-8.
[10]Etufugh CN,Phillips TJ. Venous ulcer[J]. Clin Dermat,2007,25(1):121-130. doi:10. 1016/j. clindermatol. 2006. 09. 004.
[11] Raffetto JD. Dermal pathology,cellular biology,and inflammation in chronic venous disease[J]. Thromb Res,2009,123(Suppl 4):S66-71. doi:10. 1016/S0049-3848(09)70147-1.
[12]Faler BJ,Macsata RA,Plummer D,et al. Transforming growth factorbeta and wound healing[J]. Perspect Vasc Surg Endovasc Ther,2006,18(1):55-62.
[13]Chen JH,Stoeber K,Kingsbury S,et al. Loss of proliferative capacity and induction of senescence in oxidatively stressed human fibroblasts[J]. J Biol Chem,2004,279(47):49439-49446. doi:10. 1074/jbc.M409153200.
[14]赵渝,王学虎.下肢静脉性溃疡的诊治进展[J].临床外科杂志,2016,24(8):589-591.
[15]张冠一,孟庆义.腔内激光联合泡沫硬化剂治疗下肢静脉性溃疡的疗效分析[J].中国血管外科杂志(电子版),2018,12(10):275-278. doi:10. 3969/j. issn. 1674-7429. 2018. 04. 011.
[16]侯乐伟,邓国瑜,梅志军,等.筋膜下经内镜穿通静脉离断术治疗下肢静脉性溃疡10年临床随访[J].现代生物医学进展,2014,14(20):3896-3897. doi:10. 13241/j. cnki. pmb. 2014. 20. 025.