Mayberry J C, Moneta G L, Taylor L M, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland 97201.
Surgery. 1991 May;109(5):575-81.
A nonoperative approach to venous stasis ulceration of the lower extremity, consisting of initial bedrest, ulcer cleansing, dressing changes, and ambulatory elastic compression stocking therapy, has been maintained for over 15 years. All patients had class III, severe chronic venous insufficiency. One hundred five of 113 patients (93%) experienced complete ulcer healing in a mean of 5.3 months. One hundred two patients were compliant with elastic compression stockings, and 11 patients were noncompliant. Complete ulcer healing occurred in 99 of 102 patients (97%) who were compliant versus six of 11 patients (55%) who were noncompliant (p less than 0.0001). The influence of noncompliance, previous venous ulceration, previous venous surgery, previous known deep venous thrombosis, peripheral arterial insufficiency (ankle brachial systolic blood pressure index less than or equal to 0.60), pretreatment ulcer duration, ulcer size, age, sex, diabetes, smoking, and photoplethysmography venous refill time on ulcer healing was determined by logistic regression analysis. Only noncompliance with elastic compression stockings (p less than 0.0001) and a pretreatment ulcer duration of more than 9 months (p = 0.02) significantly decreased initial ulcer healing. Posthealing follow-up was available in 73 patients for a mean of 30 months. Fifty-eight patients (79%) continued to be compliant with stockings; 15 patients were noncompliant. Total ulcer recurrence in patients who were compliant was 16%. Five-year lifetable recurrence was 29%. All patients who were noncompliant had recurrent ulceration by 36 months. Previous ulceration, previous venous surgery, and peripheral arterial insufficiency had no effect on ulcer recurrence (p greater than 0.05).
一种针对下肢静脉淤滞性溃疡的非手术治疗方法，包括初期卧床休息、溃疡清创、换药以及门诊弹性加压袜治疗，已持续应用超过15年。所有患者均为Ⅲ级严重慢性静脉功能不全。113例患者中有105例（93%）平均在5.3个月内实现溃疡完全愈合。102例患者依从弹性加压袜治疗，11例患者不依从。依从的102例患者中有99例（97%）实现溃疡完全愈合，而不依从的11例患者中有6例（55%）实现溃疡完全愈合（p<0.0001）。通过逻辑回归分析确定了不依从、既往静脉溃疡、既往静脉手术、既往已知的深静脉血栓形成、外周动脉供血不足（踝肱收缩压指数≤0.60）、治疗前溃疡持续时间、溃疡大小、年龄、性别、糖尿病、吸烟以及光电容积描记法静脉充盈时间对溃疡愈合的影响。只有不依从弹性加压袜治疗（p<0.0001）以及治疗前溃疡持续时间超过9个月（p=0.02）会显著降低初始溃疡愈合率。73例患者可进行愈合后随访，平均随访30个月。58例患者（79%）继续依从使用弹力袜；15例患者不依从。依从患者的溃疡总复发率为16%。5年生命表复发率为29%。所有不依从的患者在36个月时均出现溃疡复发。既往溃疡、既往静脉手术以及外周动脉供血不足对溃疡复发无影响（p>0.05）。
