腔内激光闭合术纠正局部血流动力学紊乱治疗继发性静脉性溃疡

目的探讨腔内激光闭合(EVLA)膝下及溃疡床周围浅静脉反流治疗继发性静脉性溃疡(SVU)的疗效。方法回顾性分析2005年1月～2008年12月在我科就诊的51例(54条患肢,72个溃疡面)SVU患者的临床资料,EVLA闭合膝下段及溃疡床周围浅静脉反流,保留膝上段大隐静脉,术后穿循序弹力袜(20～30 mmHg)。术后记录溃疡愈合率、临床症状改善情况及生活质量评分。结果术后随访6～47(平均25)个月,术后半年、1年及2年溃疡愈合率分别为81.9%(57/72)、71.4%(45/63)和69.1%(37/55)。患肢肿胀和疼痛缓解率分别为76.9%(40/52)和90%(27/30),患者生活质量较术前明显改善,且无严重并发症的发生。结论 SVU多由膝下段浅静脉反流所致,EVLA膝下段及溃疡床周围浅静脉反流纠正溃疡周围血流动力学紊乱治疗SVU安全有效。

Local hemodynamic disturbance corrected by endovenous laser ablation in managing secondary venous ulcer

Objective To evaluate the efficacy and the safety of endovenous laser ablation (EVLA) for superficial reflux below the knee and around ulcer bed in patients with secondary venous ulcer(SVU). Methods From Jan. 2005 to Dec. 2008, a retrospective analysis of patients with SVU was performed. All patients were treated by EVLA for superficial reflux below the knee and around ulcer bed, and reflux above the knee was left untreated. Medical stocks (20～30 mmHg) were used routinely after procedure. Clinical outcomes and quality-of-life (QoL) were assessed by examination and questionnaire. Results During the follow-up time with 6～47(mean,25) months, the healing rate of ulcer at 0.5, 1 and 2 years were 81.9% (57/72), 71.4% (45/63)and 69.1%(37/55), respectively. The rate of limb swelling and pain relief were 76.9% (40/52) and 90% (27/30), respectively. Clinical symptoms and QoL improved significantly without major complications. Conclusions Most SVUs occur as a venous reflux in the superficial venous system below-knee. Local hemodynamic disturbance around ulcer bed corrected by EVLA is an effective and safe method in managing SVU.