Objective To evaluate the effect of surgical management of primary venous reflux disease in lower extremity. Methods Literatures about the surgical management of venous reflux disease in lower extremity were collected and reviewed. Results In patients with primary venous reflux disease,comprehensive surgical management of concomitant superficial,deep and perforating veins might greatly improve the clinical effect. Conclusion Comprehensive surgical management will be the direction of surgical management of primary venous reflux disease in lower extremity.
目的 探讨腔镜深筋膜下交通支离断术（subfascial endoscopic perforating vein surgery，SEPS）治疗下肢静脉性溃疡的效果及优势。方法 对苏州大学附属第一医院2006年12月至2008年5月期间收治的30例下肢静脉性溃疡患者（32条患肢）实施SEPS。术后观察溃疡的愈合情况及其他症状的改善情况。结果 全组随访3～15个月（平均8.5个月），静脉性溃疡于术后27～103 d(平均65 d)内愈合，湿疹消失，色素沉着逐渐变浅； 随访期间无切口感染等并发症，未见溃疡复发及新生溃疡。结论 SEPS安全有效，损伤小，并发症少，是治疗下肢静脉性溃疡较为有效的方法。
随着人口老龄化，与老年病相关的慢性伤口护理越来越受重视。1962年，Winter［1］提出了“湿润环境促进伤口愈合”，为伤口换药奠定了现代创面换药的理论基础。20世纪80年代以来，针对各型创面研发了大量的新型敷料，如高分子薄膜敷料、泡沫敷料、水凝胶和水胶体敷料、海藻酸盐敷料、生物活性药物敷料等。正确选用敷料能加快创面修复、减少感染机会、缩短住院时间及降低医疗费用。现结合下肢静脉性溃疡的创面换药问题就如何选用各种医用敷料作一讨论……
目的 探讨腔镜深筋膜下交通支结扎（SEPS）+溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS+溃疡周围环缝术（联合治疗组）。另有SEPS组(19例)和溃疡周围环缝组(30例)作对照。所有病例均行常规大隐静脉高位结扎+剥脱术。结果 联合治疗组溃疡于术后12~60 d愈合，平均25.7 d； SEPS组于术后18~90 d愈合，平均35.1 d; 溃疡周围环缝组于术后21~90 d愈合，平均47.3 d，各组间差异均有统计学意义（P＜0.05）。3组间复发率比较，差异无统计学意义（Pgt;0.05）。结论 SEPS+溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡，2个术式联合应用其溃疡愈合时间较单独应用缩短。
ObjectiveTo understand progress of gene research for chronic venous ulcer (CVU) so as to seek for the best treatment strategy for it.MethodThe literatures about studies on gene polymorphism and variability that leaded to the occurrence and development of CVU in recent years were reviewed and analyzed.ResultsThe CVU was mainly caused by the chronic venous insufficiency (CVI). Many changes in the gene expression had been found in the curable CVU and incurable CVU. The expressions of regulated inflammatory genes, encoding extracellular peptide genes, and encoding different cellular pathways genes in the incurable CVU patients had remarkable differences as compared with the healthy individuals. Although there were more studies on incurable CVU than curable CVU, it was still unable to accurately predict the healing time of CVU. At the same time, genome-wide associations study had not been performed to find single nucleotide polymorphism related to the risk of CVU.ConclusionsAlthough CVU is mainly caused by CVI, not all patients with CVI have ulcer. At present, parts of risk factors of CVU have been known, such as age, iliofemoral vein embolism, deep vein insufficiency, hypertension, obesity, and so on. However, there are fewer studies on heredity, so it is necessary to strengthen its research. Gene expression and gene polymorphism have increasingly become focus of research on causes of chronic inflammation. Genome-wide association study is a gold standard of complex disease genetics, so it is neccessary to further search so as to better understand genetic basis and genetic background of CVU and find the best treatment strategy for improving ulcer healing.
ObjectiveTo investigate the relationship between the nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) inflammasome and inflammatory reaction of venous ulcer of lower extremity.MethodsTwenty-four patients with active venous ulcer of lower extremity (active ulcer group), 24 patients with non exudative venous ulcer of lower extremity as positive control (non-active ulcer group), and 24 patients with traumatic wound as negative control (traumatic-wound group) were enrolled. The clinical data of the three groups were compared, the tissue samples around the wound were harvested, and the expressions of NLRP3 protein were detected by immunohistochemistry among the three groups. Enzyme linked immunosorbent assay (ELISA) was used to detect the IL-1β and IL-18 protein levels, RT-PCR was used to detect the mRNA expressions of apoptosis associated speck like protein containing CARD (ASC), caspase-1, c-Jun N-terminal kinase (JNK), p38, nuclear factor (NF)-κB p65 and NF-κB inhibitor alpha (NF-κB IkBα), and Western blotting was performed to evaluate the level of NLRP3 inflammasome in wound tissues.ResultsThe inflammatory response in the non-active ulcer group and trauma-wound group were milder than that in the active ulcer group. The levels of IL-1β and IL-18 proteins in the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group [IL-1β: (146.621±11.597) ng/L vs. (80.967±14.213) ng/L vs. (84.962±19.484) ng/L, F=136.200, P<0.001; IL-18: (119.814±12.788) ng/L vs. (72.899±17.220) ng/L vs. (48.131±10.407) ng/L, F=167.910, P<0.001]. The results of RT-PCR showed that the mRNA expressions of ASC [(0.030±0.012) ng/L vs. (0.021±0.005) ng/L vs. (0.016±0.004) ng/L, F=18.106, P<0.001], caspase-1 [(0.054±0.012) ng/L vs. (0.013±0.009) ng/L vs. (0.018±0.006) ng/L, F=130.372, P<0.001], NF-κB p65 [(0.093±0.015) ng/L vs. (0.038±0.013) ng/L vs. (0.043±0.014) ng/L, F=110.950, P<0.001], NF-κB IkB-α [(0.085±0.015) ng/L vs. (0.078±0.015) ng/L vs. (0.041±0.016) ng/L, F=53.070, P<0.001], and JNK [(0.075±0.018) ng/L vs. (0.042±0.013) ng/L vs. (0.039±0.014) ng/L, F=41.271, P<0.001] in the wound tissues of the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group. And the mRNA expression of p38 in the wound tissues of the active ulcer group was lower than that in the non-active ulcer group [(0.050±0.008) ng/L vs. (0.064±0.014) ng/L, P<0.05]. The result of Western blotting showed that the relative expression level of NLRP3 protein in the wound tissues of the active ulcer group was higher than that in the trauma-wound group and non-active ulcer group (0.767±0.272 vs. 0.605±0.212 vs. 0.556±0.183, F=4.804, P=0.012).ConclusionNLRP3 inflammasome is closely related to the wound in venous ulcer of lower extremity and provides a new target to the therapy of venous ulcer of lower extremity.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
ObjectiveTo evaluate feasibility and clinical effect of individual therapy for venous ulceration of lower extremity. MethodsFrom February 2012 to February 2014, 360 cases (totally 421 lower limbs) treated by the individual therapy were analyzed retrospectively. There were 126 male and 234 female patients, with a mean age of 53 years (ranging from 45 to 78 years). The venous ulceration occurred in left limb for 176 cases, right limb for 123 cases, and both limbs for 61 cases. The individualized treatment plans were performed for all the patients according to the color Doppler before the operation. The perforating vein was ligated during the operation, and elastic stockings were wore after operation. The operation time, postoperative VAS pain score, perioperative complications, ulcer healing and recurrence were recorded. ResultsThe operations were completed in all the patients, the average operation time was 35 min. The average VAS pain score was 2.6 at 8 h after operation, the pain was disappeared nearly at 24 h after operation. The time of returning to normal activity was 3 d. The incision bleeding occurred in 5 cases, the ulcer infection occurred in 32 lower limbs. The patients were followed-up for 12 months to 24 months, all the ulcers were healed, there were 9 cases of recurrence. ConclusionIndividual therapy for venous ulceration of lower extremity is safe, effective, fewer complications, fast ulcer healing, and less postoperative pain.