CAJ | 학술논문

目的分析复发性静脉溃疡的原因及再次手术策略.方法回顾性分析2000年1月至2010年6月收治的复发性静脉性溃疡患者的临床资料.共73例患者81条肢体入组,男性55例(60条肢体),女性18例(21条肢体),平均年龄52.6岁(31～73岁).所有患者入院前均因下肢静脉溃疡接受过一次或数次手术.溃疡复发距上次手术8～37个月,平均10.6个月;溃疡直径1.3～6.5 cm,平均3.7 cm.再次手术前多普勒超声发现小腿交通静脉反流57条肢体(70.4%),原发性深静脉瓣膜功能不全38条肢体(46.9%),DVT后遗症16条肢体(19.8%),大隐静脉属支残留11条肢体(13.6%),大隐静脉主干再通或残留8例(9.9%).针对存在的病因采取大隐静脉高位结扎抽剥及属支结扎、内镜深筋膜下交通静脉结扎、溃疡周边环形缝扎、曲张静脉环形缝扎加切除、深静脉瓣膜修复术以及穿着弹力袜等治疗措施.结果随访3～60个月,平均37.3个月.3个月时溃疡平均直径明显缩小,6个月时溃疡完全愈合,血流动力学指标明显改善.1年后3条肢体(3.7%)溃疡再次复发.结论小腿交通静脉功能不全、深静脉瓣膜功能不全以及大隐静脉再通或属支残留是静脉性溃疡术后复发的主要原因,针对性的冉次手术仍然可以达到满意疗效.
목적 분석복발성정맥궤양적원인급재차수술책략.방법 회고성분석2000년1월지2010년6월수치적복발성정맥성궤양환자적림상자료.공73례환자81조지체입조,남성55례(60조지체),녀성18례(21조지체),평균년령52.6세(31～73세).소유환자입원전균인하지정맥궤양접수과일차혹수차수술.궤양복발거상차수술8～37개월,평균10.6개월;궤양직경1.3～6.5 cm,평균3.7 cm.재차수술전다보륵초성발현소퇴교통정맥반류57조지체(70.4%),원발성심정맥판막공능불전38조지체(46.9%),DVT후유증16조지체(19.8%),대은정맥속지잔류11조지체(13.6%),대은정맥주간재통혹잔류8례(9.9%).침대존재적병인채취대은정맥고위결찰추박급속지결찰、내경심근막하교통정맥결찰、궤양주변배형봉찰、곡장정맥배형봉찰가절제、심정맥판막수복술이급천착탄력말등치료조시.결과 수방3～60개월,평균37.3개월.3개월시궤양평균직경명현축소,6개월시궤양완전유합,혈류동역학지표명현개선.1년후3조지체(3.7%)궤양재차복발.결론 소퇴교통정맥공능불전、심정맥판막공능불전이급대은정맥재통혹속지잔류시정맥성궤양술후복발적주요원인,침대성적염차수술잉연가이체도만의료효.
Objective To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation. Methods Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52. 6 years(ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months ( ranging from 5 to 37 months). Average diameter of ulcers was 3. 7 cm ( ranging from 1. 3 to 6. 5 cm) . Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70. 4% ) , primary deep vein insufficiency in 38 limbs (46. 9% ) ,post-DVT syndrome in 16 limbs (19. 8% ) , reflux of accessory saphenous veins in 11 limbs (13. 6% ) and residual/re-opened great saphenous vein in 8 limbs ( 9. 9% ) . Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality. Results All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation.Only 3 limbs (3.7% ) suffered again from recurrence 1 year after re-operation. Conclusions Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.