本文關鍵詞：下肢靜脈曲張并潰瘍的綜合治療效果分析　出處：《昆明醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 下肢慢性靜脈性潰瘍 下肢靜脈曲張 潰瘍周圍環(huán)形縫扎術 大隱靜脈高位結扎剝脫術

【摘要】：[目的]下肢靜脈性潰瘍是血管外科常見且難治的一種疾病,是下肢慢性靜脈功能不全性疾病(chronic venous insufficiency, CVI)的一種常見的并發(fā)癥之一。主要表現(xiàn)為足靴區(qū)、內外踝及足背等處皮膚潰瘍形成、色素沉著,潰瘍可為單發(fā),也可多發(fā)。如無特殊治療,潰瘍經(jīng)久不愈或者反復發(fā)作,且有惡變可能。對患者的健康及生活質量造成嚴重影響,增加患者經(jīng)濟負擔。因下肢靜脈性潰瘍是由深、淺靜脈及交通靜脈功能不全共同作用的結果,所以其治療上必須同時糾正下肢各靜脈系統(tǒng)的功能不全的情況,本課題收集了近五年來我院胸心血管外科收住的78例下肢靜脈曲張并潰瘍患者,分析其綜合治療效果及預后,為以后的治療提供經(jīng)驗。[方法]選取2011年1月至2015年12月在我院胸心血管外科住院的78例下肢靜脈曲張并潰瘍患者的臨床資料及隨訪資料進行回顧性研究。比較患者經(jīng)大隱靜脈高位結扎剝脫術、潰瘍周圍環(huán)形縫扎術及股淺靜脈瓣膜戴戒術等綜合治療后的各種臨床癥狀、體征改善情況。所有統(tǒng)計資料均采用SPSS17.0軟件進行統(tǒng)計學處理,采用t檢驗,百分率的95%可信區(qū)間(95%CI),結果用x±S表示,P0.05為差異有統(tǒng)計學意義。[結果]本研究組78例患者共93條患肢均行大隱靜脈高位結扎剝脫術及潰瘍周圍環(huán)形縫扎術,7條深靜脈瓣重度返流肢體同時行股淺靜脈第一對瓣膜戴戒術。術后隨訪3到6月,愈合率91.4%,8條肢體術后隨訪6月后潰瘍面積較前明顯縮小,皮膚脂質硬化及色素沉著等情況均較前明顯改善。隨訪過程中有8條患肢潰瘍于其他部位復發(fā),復發(fā)率8.6%,再次予潰瘍周圍環(huán)形縫扎術后潰瘍愈合。所有患者術后均無淺靜脈曲張復發(fā)及血栓形成,無切口感染情況發(fā)生。7例同時行股淺靜脈戴戒術及淺靜脈手術的患者術后潰瘍均愈合,無淺靜脈曲張發(fā)生。采用CEAP分類中臨床評分來比較患者肢體臨床癥狀體征的狀況及評估治療效果,比較所有患者術前及術后3到6月各項臨床癥狀的評分,統(tǒng)計顯示所有患者術后各項癥狀、體征均較術前有明顯的改善P0.01。[結論]1.潰瘍周圍環(huán)形縫扎術聯(lián)合淺靜脈剝脫術及股淺靜脈瓣膜成形術綜合治療,是治療下肢慢性靜脈曲張性潰瘍的有效方法。2.下肢靜脈性潰瘍需同時糾治深、淺靜脈、交通靜脈及肌泵系統(tǒng)的功能。3.潰瘍周圍環(huán)形縫扎術處理交通靜脈操作簡單,創(chuàng)傷小,術后感染率低,是一種有效的手術方法。
[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 鹵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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R654.4
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本文編號：1436953