下肢静脉曲张并溃疡的综合治疗效果分析

发布时间：2018-01-17 16:07

  本文关键词：下肢静脉曲张并溃疡的综合治疗效果分析　出处：《昆明医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 下肢慢性静脉性溃疡 下肢静脉曲张 溃疡周围环形缝扎术 大隐静脉高位结扎剥脱术

【摘要】：[目的]下肢静脉性溃疡是血管外科常见且难治的一种疾病,是下肢慢性静脉功能不全性疾病(chronic venous insufficiency, CVI)的一种常见的并发症之一。主要表现为足靴区、内外踝及足背等处皮肤溃疡形成、色素沉着,溃疡可为单发,也可多发。如无特殊治疗,溃疡经久不愈或者反复发作,且有恶变可能。对患者的健康及生活质量造成严重影响,增加患者经济负担。因下肢静脉性溃疡是由深、浅静脉及交通静脉功能不全共同作用的结果,所以其治疗上必须同时纠正下肢各静脉系统的功能不全的情况,本课题收集了近五年来我院胸心血管外科收住的78例下肢静脉曲张并溃疡患者,分析其综合治疗效果及预后,为以后的治疗提供经验。[方法]选取2011年1月至2015年12月在我院胸心血管外科住院的78例下肢静脉曲张并溃疡患者的临床资料及随访资料进行回顾性研究。比较患者经大隐静脉高位结扎剥脱术、溃疡周围环形缝扎术及股浅静脉瓣膜戴戒术等综合治疗后的各种临床症状、体征改善情况。所有统计资料均采用SPSS17.0软件进行统计学处理,采用t检验,百分率的95%可信区间(95%CI),结果用x±S表示,P0.05为差异有统计学意义。[结果]本研究组78例患者共93条患肢均行大隐静脉高位结扎剥脱术及溃疡周围环形缝扎术,7条深静脉瓣重度返流肢体同时行股浅静脉第一对瓣膜戴戒术。术后随访3到6月,愈合率91.4%,8条肢体术后随访6月后溃疡面积较前明显缩小,皮肤脂质硬化及色素沉着等情况均较前明显改善。随访过程中有8条患肢溃疡于其他部位复发,复发率8.6%,再次予溃疡周围环形缝扎术后溃疡愈合。所有患者术后均无浅静脉曲张复发及血栓形成,无切口感染情况发生。7例同时行股浅静脉戴戒术及浅静脉手术的患者术后溃疡均愈合,无浅静脉曲张发生。采用CEAP分类中临床评分来比较患者肢体临床症状体征的状况及评估治疗效果,比较所有患者术前及术后3到6月各项临床症状的评分,统计显示所有患者术后各项症状、体征均较术前有明显的改善P0.01。[结论]1.溃疡周围环形缝扎术联合浅静脉剥脱术及股浅静脉瓣膜成形术综合治疗,是治疗下肢慢性静脉曲张性溃疡的有效方法。2.下肢静脉性溃疡需同时纠治深、浅静脉、交通静脉及肌泵系统的功能。3.溃疡周围环形缝扎术处理交通静脉操作简单,创伤小,术后感染率低,是一种有效的手术方法。
[Abstract]:[Objective] Venous ulcer of lower extremity is a common and difficult disease in vascular surgery. It is a chronic venous insufficiency of lower extremity chronic venous insufficiency. One of the most common complications of CVI is the formation of skin ulcers in the boot area, medial and lateral malleolus, and the back of the foot, with pigmentation, ulcers may be single or multiple, if no special treatment is required. Ulcers do not heal for a long time or recurrent attacks, and have the possibility of malignant change. It has a serious impact on the health and quality of life of patients, increase the economic burden of patients. Because the lower extremity venous ulcers are deep. The superficial vein and the communication vein function insufficiency result together, therefore its treatment must at the same time correct the lower extremity venous system insufficiency situation. In this paper, 78 patients with varicose veins and ulcers of lower extremity received by thoracic and cardiovascular surgery in our hospital in recent five years were collected. The comprehensive treatment effect and prognosis were analyzed, which provided experience for future treatment. [Methods the clinical data and follow-up data of 78 patients with varices and ulcers of lower extremity who were hospitalized in thoracic and cardiovascular surgery from January 2011 to December 2015 were retrospectively studied. High ligation and exfoliation of great saphenous vein. All the clinical symptoms and signs were improved after comprehensive treatment such as ring suture around ulcers and superficial femoral vein valve ring. All the statistical data were statistically processed by SPSS17.0 software. Using t test, the 95% confidence interval of the percentage was 95%. The result showed that there was significant difference between the two groups in terms of x 卤S (P 0.05). [Results] 93 limbs of 78 patients in this study group were treated with high ligation and exfoliation of great saphenous vein and circular suture around ulcers. Seven deep venous valves with severe regurgitation were performed simultaneously with the first pair of superficial femoral vein valves. The healing rate was 91.4% and 8 limbs were followed up from 3 to June. The ulcer area was significantly reduced after June. The skin lipid sclerosis and pigmentation were improved obviously. During the follow-up, 8 ulcers recurred in other parts, the recurrence rate was 8.6%. All the patients had no recurrence of varicose veins and thrombosis. No incision infection occurred in 7 cases of superficial femoral vein ring wearing and superficial vein surgery ulcer healing after operation. There was no superficial varicose vein. The clinical scores in CEAP classification were used to compare the clinical symptoms and signs of the patients and to evaluate the therapeutic effect. The scores of all patients' clinical symptoms before and after operation from 3 to June were compared. The statistical results showed that the symptoms and signs of all patients were significantly improved than those before operation (P 0.01). [Conclusion: 1. Combined with superficial vein exfoliation and superficial femoral vein valvuloplasty. 2. It is an effective method for the treatment of chronic varicose ulcer of lower extremity. 2. The deep and superficial veins of lower extremity venous ulcer should be corrected at the same time. The function of the communicating vein and muscle pump system .3.The circular suture around the ulcer is an effective method for the treatment of the communicating vein, the operation is simple, the trauma is small, and the infection rate is low.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.4
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本文编号：1436953