中国实用外科杂志

中国实用外科杂志

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基底扇形穿刺激光烧灼术治疗下肢静脉性溃疡临床研究

汪    涛，赵    珺，梅家才，邵明哲，潘    烨，张    健，吴海生，张    震，于    敏   

  1. 上海交通大学医学院附属第六人民医院血管外科，上海200233
  • 出版日期:2015-12-01 发布日期:2015-12-01

  • Online:2015-12-01 Published:2015-12-01

摘要：

目的    探讨基底扇形穿刺皮下激光烧灼术在下肢静脉性溃疡(venous ulcers)中的临床效果。方法    将上海交通大学医学院附属第六人民医院2010年1月至2015年5月间收治的104例下肢静脉性溃疡的病人分为两组，实验组在常规激光静脉腔内闭合术（endovenous laser therapy，EVLT）治疗基础上，同时在溃疡基底处多点扇形穿刺激光烧灼；对照组予常规激光静脉腔内闭合术治疗。两组术中、术后常规清创换药。统计随访期内两组病人下肢溃疡的愈合率、愈合时间以及术后并发症痛感（burning sensation）、下肢水肿（limb edema）、皮肤瘀斑（ecchymosis）、麻木感（numbness）和皮肤灼伤（skin burns）的发生率，并通过Kaplan-Meier生存表分析两组病人溃疡愈合时间。结果    实验组病人溃疡愈合率明显高于对照组（85.5% vs. 52.4%，χ2=25.658，P=0.00），溃疡生存时间明显低于对照组［（2.59±0.11）周 vs. （3.12±0.16）周，χ2=6.133，P=0.01）］。两组病人术后下肢痛感、水肿、皮肤瘀斑、麻木感和皮肤灼伤的发生率差异均无统计学意义（P>0.05），且无明显不良反应及并发症的发生。结论    基底扇形穿刺皮下激光烧灼术具有良好临床效果，且具有安全性。

关键词: 扇形穿刺法, 激光, 静脉性溃疡

Abstract:

Under-ulcer sector-punctured ablation in the laser treatment of lower limb venous ulcers        WANG Tao，ZHAO Jun，MEI Jia-cai，et al. Department of Vascular Surgery，the Sixth Affiliated Hospital, Shanghai Jiao Tong University School of Medicine， Shanghai 200233，China
Corresponding author：ZHAO Jun，E-mail：junnzhao@126.com
Abstract    Objective    To evaluate the method of under-ulcer sector-punctured ablation in the laser treatment of lower limb venous ulcers. Methods    A total of 104 patients with lower limb venous ulcers admitted between January 2010 and May 2015 in the Sixth Affiliated Hospital, Shanghai Jiao Tong University School of Medicine were divided into two groups. Patients underwent routine endovascular venous laser therapy (EVLT) plus under-ulcer sector-punctured ablations were set into the study group，while routine EVLT as the controlled group. All the patients received the dressing change after operations. The ulcer healing rate，healing time，numbness，burning sensation，ecchymosis，skin burns and the incidence of limb edema in the two groups were revealed. The ulcer healing time of the two groups were calculated by Kaplan-Meier analysis. Results    The ulcers healing rate in study group was significantly higher than that in control group (85.5% vs. 52.4%，χ2=25.658，P=0.00)，while the ulcer survival time was much lower （2.59±0.11）w vs. （3.12±0.16）w，χ2=6.133，P=0.01). There was no significant difference in the numbness，burning sensation，ecchymosis，skin burns and the incidence of limb edema between the two groups (P>0.05); Neither adverse invents nor complication occurred. Conclusion    The method of under-ulcer sector-punctured ablation blocked the reflux in perforator veins seems to be a satisfied，safe therapy in the laser treatment of lower limb venous ulcer.

Key words: sector puncture, laser, venous ulcers