深静脉血栓后遗综合征继发溃疡的外科治疗

目的：探讨深静脉血栓后遗综合征（post thrombotic syndrome,PTS）继发溃疡的手术治疗及预防。方法：对48例PTS继发下肢慢性溃疡患者,通过溃疡创面换药等处理后,行溃疡周围区域性浅静脉剥脱、结扎以及交通静脉结扎,或联合静脉转流、腘静脉肌袢成形术,然后对溃疡面进行游离植皮或术后换药处理直至溃疡愈合。溃疡愈合后患肢穿弹力袜或绑弹力绷带进行弹力支持等综合治疗以预防溃疡复发。结果：溃疡面积小于25cm^2的14例患者术后创面换药2-4周愈合,19例面积在25-50cm^2之间的患者中6例联合一期植皮,术后2-3周愈合,未植皮者13例经换药12-16周仅4例面积小于35cm^2者愈合,未愈9例患者二期植皮后2-4周愈合。面积大于50cm^2全部一期植皮,术后2-4周愈合。随访40例,时间6月至8年,5例溃疡复发,复发率12.5%。结论：行溃疡周围区域性浅静脉结扎、剥脱及交通静脉结扎术是治疗PTS继发溃疡的有效方法,对面积大于25cm^2应联合一期植皮,促进愈合,术后弹力支持治疗是预防其复发的重要措施。

SURGICAL TREATMENT OF ULCER POST-THROMBOTIC SYNDROME

Objective： To investigate the treatment of the ulcer of post-thrombotic syndrome（PTS）. Methods： 48 cases suffered chronic ulcer of PTS were examined with lower extremity ascending venography. The following methods were conducted raising the affected limbs cultivating the bacteria surrounding the ulcer anti-infection and so on. At the same time, some of them accepted different venous operation, all of them accepted the operation of striping the superficial vein around ulcer and ligating the traffic vein. The elastic stock or bandage were introduced to all patients in order to prevent relapse of the ulcer. Results： In the 48 cases, the healing time were different according to different ulcer areas, the wider the ulcer area , the longer the healing time . 40 cases were accepted followed up from 6 months to 8 years, 3 cases were relapsed. Conclusion： As far as the ulcer of PTS were concerned, striping the superficial vein around the ulcer and ligating the traffic vein are the effective way. If the ulcer area exceeds 25 cm^2, primary skin-graft should be conducted to promote ulcer healing, and the elastic force is an important method to prevent relapse of the ulcer.