CAJ | 학술논문

目的探讨下肢静脉性溃疡的微创治疗效果.方法对48例(56侧)下肢静脉性溃疡通过静脉造影检查明确引起溃疡的原发病变,根据患肢血流动力学异常的种类和程度对8例(8侧)行大隐静脉高位结扎联合静脉腔内激光治疗(EVLT)+内镜深筋膜下交通静脉离断术(SEPS)+股浅静脉瓣膜戴戒术;24例(28侧)行大隐静脉高位结扎+EVLT+SEPS;16例(20侧)行大隐静脉高位结扎+EVLT.溃疡均行周缘环行缝扎.结果术后56侧患肢浅静脉曲张均消失,皮肤色素沉着、湿疹样改变均明显减轻;51侧小腿酸胀沉重感、疼痛、水肿14～18 d消失,溃疡16～48 d愈合.随访4～46个月,平均(24.8 4±.5)个月,4侧(7.1%)肢体溃疡复发.结论纠正浅静脉、交通支静脉、深静脉功能不全和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法,EVLT和SEPS操作简便、微创、安全,联合股浅静脉瓣膜戴戒术可以有效地减少下肢静脉性溃疡的复发.
목적 탐토하지정맥성궤양적미창치료효과.방법 대48례(56측)하지정맥성궤양통과정맥조영검사명학인기궤양적원발병변,근거환지혈류동역학이상적충류화정도대8례(8측)행대은정맥고위결찰연합정맥강내격광치료(EVLT)+내경심근막하교통정맥리단술(SEPS)+고천정맥판막대계술;24례(28측)행대은정맥고위결찰+EVLT+SEPS;16례(20측)행대은정맥고위결찰+EVLT.궤양균행주연배행봉찰.결과 술후56측환지천정맥곡장균소실,피부색소침착、습진양개변균명현감경;51측소퇴산창침중감、동통、수종14～18 d소실,궤양16～48 d유합.수방4～46개월,평균(24.8 4±.5)개월,4측(7.1%)지체궤양복발.결론 규정천정맥、교통지정맥、심정맥공능불전화중시궤양창면적처리시치료하지정맥성궤양적유효요법,EVLT화SEPS조작간편、미창、안전,연합고천정맥판막대계술가이유효지감소하지정맥성궤양적복발.
Objective To study the efficacy of minimally invasive treatment for lower extremities venous ulcers.Methods A total of 48 patients with lower extremities venous ulcers(56 hmbs)wereexamined with venography to identify the primary lesion that resulted ulcer. According to the type and degree of hemedynamie abnormality,high ligation of the great saphenous vein combined with endovenous laser treatment,subfascial endoscopic perforator surgery,and external banding valvuloplasty of the superficial femoral vein were done in 8 eases(8 limbs),high ligafion of the great saphenous vein combined with endovenous laser treatment and subfascial endoscopic perforator surgery were carried out in 24 cases(28 limbs),and high figation of the great saphenous vein combined with endovenous laser treatment was performed on 16 cases(20 linbs).In all cases,the ulcers were eircumferentially ligated at the same time.Results After the operations,superficial varicosis,pigmentations,and eczematous relieved remarkably in the 56 limbs.In 51 limbs,heavy feeling,ache,and edema disappeared 14-18 days after operation.The ulcers of the 56 limbs healed l6-48 days after operation.During 4 to 46 months follow up,ulcers recurred in 4 limbs(7.1%).Conclusions It is effective to correct the incompetence of the superficial,perforating,and deep veins and manage the surface of ulcers for lower extremities venous ulcers.Endovenous Iaser treatment and subfascial endoscopic perforator surgery are easily performing,minimally invasive,and safe operations.The recurrence of leg ulcers can be reduced by external banding valvuloplasty of the superficial femoral vein.