de Carvalho Magali Rezende
Magali Rezende de Carvalho, RN, BSN, WOC nurse, School of Nursing Aurora de Afonso Costa, Universidade Federal Fluminense, Niterói, RJ, Brazil.
J Wound Ostomy Continence Nurs. 2015 Jan-Feb;42(1):42-6; quiz E1-2. doi: 10.1097/WON.0000000000000079.
Venous leg ulcers (VLUs) are the most prevalent type of lower extremity ulcers and can be difficult to manage. Clinicians are challenged to provide care and recommendations that promote timely healing, minimize the risk of recurrence, and are cost-effective. Compression therapy is generally considered the primary intervention for both ulcer management and prevention of recurrence. However, recent studies suggest that surgical correction of venous insufficiency may enhance healing of venous ulcers or help prevent recurrence.
The objective of this systematic review was to compare wound healing and recurrence rates in patients managed with compression therapy alone versus compression therapy plus surgery.
The author conducted a literature review selecting primary studies published between 2002 and 2012, using the electronic databases MEDLINE/PubMed and CINAHL/EBSCOhost. The following key words were applied: leg ulcer; varicose ulcer; bandage; "stockings, compression," venous ulceration; venous ulcer; compressive therapy; compression therapy; stocking; venous surgery. Inclusion criteria included randomized controlled trials that compared VLU healing rates and recurrence rates among patients receiving compression therapy alone, and patients receiving both compression therapy and surgical intervention to correct venous incompetence. Studies published in English, Spanish, or Portuguese were included.
Sixty-seven studies were retrieved and 4 were identified that met inclusion criteria. In 3 of the studies, researchers reported no differences in healing rates for patients managed with compression plus surgery when compared to patients managed with compression alone. One study reported higher healing rates in the surgical group. Most studies revealed lower recurrence rates in patients who were managed with surgery plus compression, but these differences were not statistically significant.
Existing evidence supports compression therapy as the most critical element in the management of venous leg ulcers. However, evidence also suggests that surgical obliteration of incompetent perforator veins may promote longer ulcerfree periods and lower rates of recurrence.
下肢静脉溃疡（VLUs）是最常见的下肢溃疡类型，且难以处理。临床医生面临着提供促进及时愈合、将复发风险降至最低且具有成本效益的护理和建议的挑战。压力治疗通常被认为是溃疡处理和预防复发的主要干预措施。然而，最近的研究表明，手术纠正静脉功能不全可能会促进静脉溃疡的愈合或有助于预防复发。
本系统评价的目的是比较单纯采用压力治疗与压力治疗加手术治疗的患者的伤口愈合率和复发率。
作者进行了一项文献综述，选择了2002年至2012年间发表的原始研究，使用电子数据库MEDLINE/PubMed和CINAHL/EBSCOhost。应用了以下关键词：腿部溃疡；静脉曲张溃疡；绷带；“压力袜”；静脉溃疡；静脉溃疡；压力治疗；压迫疗法；袜子；静脉手术。纳入标准包括随机对照试验，该试验比较了单纯接受压力治疗的患者与接受压力治疗和手术干预以纠正静脉功能不全的患者的VLU愈合率和复发率。包括以英文、西班牙文或葡萄牙文发表的研究。
检索到67项研究，其中4项符合纳入标准。在3项研究中，研究人员报告说，与单纯接受压力治疗的患者相比，接受压力治疗加手术的患者的愈合率没有差异。一项研究报告手术组的愈合率更高。大多数研究表明，接受手术加压力治疗的患者复发率较低，但这些差异无统计学意义。
现有证据支持压力治疗作为下肢静脉溃疡管理中最关键的要素。然而，证据也表明，手术闭塞功能不全的交通静脉可能会促进更长的无溃疡期和更低的复发率。
