Yamamoto Kenji, Miwa Senri, Yamada Tomoyuki, Setozaki Shuji, Hamuro Mamoru, Kurokawa Shunji, Enomoto Sakae
Okamura Memorial Hospital, Sunto-gun, Japan.
Shiga General Hospital, Moriyama, Japan.
Wounds. 2022 Apr;34(4):99-105. doi: 10.25270/wnds/2022.99105.
Venous ulcers are often intractable.
The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers.
Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome.
Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13-365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3-66 months]).
Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.
静脉性溃疡通常难以治疗。
本研究旨在回顾性分析腔内消融、加压治疗、湿性伤口愈合及皮肤护理在静脉性溃疡治疗中的有效性。
2014年12月至2020年8月期间，连续28例临床-病因-解剖-病理生理（CEAP）分级为C6级的静脉性溃疡患者接受了腔内消融治疗。主要治疗策略包括射频消融和曲张静脉切除术（包括对功能不全的穿支静脉进行小切口撕脱术），使用加压治疗直至溃疡完全愈合，湿性伤口愈合（每天两次清洗溃疡部位并覆盖敷料），以及考虑微生物群平衡的皮肤护理。
初诊时36例患者被诊断为活动性下肢静脉溃疡（CEAP C6级）。其中7例患者通过加压治疗及促进湿性伤口愈合的策略，在计划手术当天溃疡愈合。1例患者因无法戒烟，因此未能接受手术。排除这8例患者后，作者分析了28例行腔内消融治疗患者的数据。平均手术时间为38.9分钟，平均小切口撕脱术切口部位数量为9.7个。所有溃疡均在中位时间55.5天（范围13 - 365天）内愈合。28例患者在1年内均实现溃疡愈合（100%）。截至最后一次随访（中位时间24.5个月[范围3 - 66个月]），无溃疡复发。
腔内消融、充分的曲张静脉切除术（小切口撕脱术[1例患者最多43个部位]）、加压治疗、湿性伤口愈合及皮肤护理在治疗和预防静脉性溃疡复发方面有效。
