| 摘要: |
| 目的 探讨数字减影血管造影(DSA)引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的技术方法、可行性、安全性和临床疗效。方法 选择我院收治的静脉曲张伴溃疡患者36例(48条患肢),患肢溃疡面积1~7 cm2,均为内踝处溃疡。术中于腹股沟小切口高位结扎大隐静脉主干后,经大隐静脉远侧断端或经皮穿刺患肢内踝处大隐静脉,置入4F造影导管,DSA引导下经导管注入聚桂醇泡沫硬化剂,选择性硬化闭塞大隐静脉及交通静脉,5 cm2以上溃疡清创植皮,5 cm2以下溃疡灭菌油纱布覆盖。术后即刻穿腿长Ⅰ级循环减压弹力袜,2周后换穿膝长Ⅱ 级循环减压弹力袜3~6个月。术后预防性应用抗生素、局部换药。结果 在DSA引导下48 条患肢均成功注入泡沫硬化剂,每条患肢平均注入6.5 mL (3.5~8.5 mL),无严重并发症发生。术后当日患者能下床活动,2周后,38条患肢(79.2%)下肢溃疡创面愈合,8条患肢(16.7%)溃疡创面明显缩小,2条患肢(4.2%)创面未扩大。6~12 个月后随访,45 条患肢(93.8%)曲张静脉及溃疡消失,3条患肢(6.2%)溃疡复发。结论 DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡安全、微创、有效,给术后溃疡创面短期快速愈合提供了可能。 |
| 关键词: 静脉曲张溃疡 聚桂醇 泡沫 硬化疗法 |
| DOI：10.3724/SP.J.1008.2013.0088 |
| 投稿时间：2012-08-08修订日期：2012-11-09 |
| 基金项目:江苏省医学创新团队与领军人才项目(LJ201134). |
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| DSA-guided foam sclerotherapy with lauromacrogol in treatment of lower extremity varicose ulcer |
| ZHENG Xiao-bing,WANG Qing-qing,CHANG Ren-an,HE Zhi-xian |
(Department of Vascular Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China
*Corresponding author.) |
| Abstract: |
| Objective To introduce the technique of DSA-guided foam sclerotherapy and evaluate its feasibility,safety and curative effects for treatment of lower extremity varicose ulcer (LEVU). Methods A total of 48 legs in 36 selected LEVU patients received DSA-guided foam sclerotherapy with lauromacrogol, with the area of varicose ulcer being 1-7 cm2. After high ligation of the great saphenous vein, DSA-guided foam sclerotherapy was performed using 4F catheter to inject the foam of lauromacrogol into the lower extremity varicose to selectively block the great saphenous vein and communicating vein. Ulcer with area larger than 5 cm2 was treated with debridement and skingrafting, and that smaller than 5 cm2 was covered with sterilizing vaseline gauze. All cases wore Ⅰ class compression elastic stockings in the first week after operation and wore Ⅱ class compression elastic stockings from the second week for 3 to 6 months. All patients were given postoperative prophylactic antibiotics and local dressings were changed regularly. Results The procedure was technically successful for all the 48 legs. The injected sclerosant volume ranged from 3.5-8.5 mL for each patient,with an average dose being 6.5 mL; there were no serious complications. The patients could get down the bed and move about on the day after treatment. Two weeks later the ulcer was cured in 38 (79.2%) limbs, reduced in size in 8 (16.7%) limbs, and remained unchanged in 2 (4.2%) limbs. The varicose ulcer disappeared in 45 (93.8%) limbs during 6-12 months follow-up, and 3 (6.2%) limbs had recurrent ulcer. Conclusion DSA-guided foam sclerotherapy of lauromacrogol is a safe, mini-invasive and effective treatment for LEVU, which makes it possible for quick healing of the ulcer after operation. |
| Key words: varicose ulcer lauromacrogol foam sclerotherapy |
