Dunn J M, Cosford E J, Kernick V F, Campbell W B
Royal Devon & Exeter Hospital, Wonford.
Ann R Coll Surg Engl. 1995 Nov;77(6):421-4.
We have reviewed the results of treatment of 159 consecutive limbs presenting with a clinical diagnosis of venous ulcer in 140 patients (70 male, aged 28-90 years, median 66 years). Of the patients, 61% were referred because of severe pain and 53% of the ulcers had been present > 2 years. Patients were evaluated clinically and by Doppler, with selective use of venography, photoplethysmography, arteriography and latterly duplex scanning. Seventy-one limbs had surgery to the superficial veins, 18 limbs had arterial reconstruction, and 10 limbs had skin grafting alone. There was one operative death after arterial reconstruction but none after venous surgery. Patients were followed up for 1-5 years (median 3 years). Of those who had been treated surgically, healing was achieved in 88%, and ulcers healed in 52% of those treated non-operatively. In all, 18% of the ulcers recurred in each group. These results show a favourable association between appropriate venous and arterial surgery and the healing of venous ulcers, with relief of pain. They support a policy of thorough evaluation and appropriate surgical treatment in these patients.
我们回顾了140例（70例男性，年龄28 - 90岁，中位数66岁）临床诊断为静脉性溃疡的连续159条肢体的治疗结果。这些患者中，61%因剧痛前来就诊，53%的溃疡已存在超过2年。对患者进行了临床评估及多普勒检查，并选择性地使用了静脉造影、光电容积描记法、动脉造影以及后来的双功能超声扫描。71条肢体接受了浅静脉手术，18条肢体进行了动脉重建，10条肢体仅接受了植皮手术。动脉重建术后有1例手术死亡，静脉手术后无死亡病例。患者随访1 - 5年（中位数3年）。接受手术治疗的患者中，88%实现了愈合，非手术治疗的患者中52%的溃疡愈合。总体而言，每组中18%的溃疡复发。这些结果表明，适当的静脉和动脉手术与静脉性溃疡的愈合以及疼痛缓解之间存在良好的关联。它们支持对这些患者进行全面评估和适当手术治疗的策略。
