ObjectiveTo evaluate the clinical experiences and treatment effectiveness of chronic venous insufficiency with venous ulcer in lower limb. MethodsSeventy-eight patients (88 limbs) suffering lower limb chronic venous insufficiency with venous ulcer from May 2004 to April 2011 in this hospital were analyzed retrospectively. All the patients had undergone high ligation for great saphenous vein plus endovenous laser treatment plus subfascial endoscopic perforator vein surgery (SEPS). ResultsPostoperative complications included 3 cases of subfascial haematoma; 2 cases of pneumohypoderma; 3 cases of numbness in anterior tibial and ankle areas. All the ulcers healed between 4 to 6 weeks. Follow up period was between 6 months to 5 years. There was only one recurrence due to residual varicose from ankle area. The mean operation time was 20 min (15－30 min) in SEPS, the average blood loss was 2 ml (1－5 ml), and the mean duration of postoperative hospitalization was 5 d (2－8 d). ConclusionsSEPS is a first treatment choice for CVI with venous ulcer. It has less invasiveness, lower chances for bleeding, shorter operation time, quicker recovery, and fewer complications.
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.
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 analyze the clinical effect of vacuum-assisted closure in treating venous ulcer. MethodsThirty seven patients including 21 males and 16 females with lower extremity venous ulcer treated in our hospital from January 2013 to January 2014 were included in our study. Based on random number table, the patients were divided into treatment group [n=19, (66.47±6.22) years old] and control group [n=18, (66.39±5.37) years old]. The treatment group received vacuum-assisted closure, while the control group underwent routine moist therapy. Wound healing and visual analogue pain scores were observed. Chi-square test and t-test were used for statistical analysis. ResultsWound healing rate was 84.2% in the treatment group and 55.6% in the control group, and the difference between the two groups was statistically significant (χ2=26.66, P<0.05). Wound healing time was (13.84±3.13) days in the treatment group and (27.35±1.73) days in the control group, and the difference was statistically significant (t=-7.498, P<0.01). Visual analogue pain scores in the treatment group was 3.53±0.51, and in the control group, it was 4.41±0.51, and the difference was statistically significant (t=-5.197, P<0.01). ConclusionVacuum-assisted closure can significantly improve wound healing and alleviate sufferings in the treatment of venous ulcer.
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 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 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.
ObjectiveTo explore the differentially expressed genes (DEGs) in venous leg ulcer (VLU) by bioinformatics, and further explore the molecular mechanism of the disease, predict early diagnostic markers and treatment targets.MethodsThe expression profiles of VLU were downloaded from the gene expression omnibus (GEO) database, the DEGs of VLU and inflammatory phase of normal skin healing were identified by R software and used to perform gene ontology (GO) and KEGG pathway enrichment analysis, obtaining the key genes of the pathway. We analyzed the proteins of protein interaction (PPI) network by STRING database and Cytoscape 3.2.1 software to obtain hub genes.ResultsA total of 409 DEGs were obtained, including 173 upregulted genes and 236 downregulted genes. The GO analysis showed that the upregulated DEGs mainly distributed in collagen-containing extracellular matrix (ECM), cornified envelope and collagen trimer, involved in biological processes such as skin development, keratinocyte differentiation and cornification, which mediated molecular functions such as ECM structural constituent, ECM structural constituent conferring tensile strength and integrin binding. The downregulated DEGs mainly distributed in tertiary granule, secretory granule membrane and tertiary granule membrane cornification, involved in biological processes such as response to chemokine, leukocyte migration and neutrophil chemotaxis, which mediated molecular functions such as chemokine activity, chemokine receptor binding and cytokine activity. KEGG pathway enrichment analysis results showed that the upregulated DEGs were mainly enriched in ECM-receptor interaction and protein digestion and absorption pathways, collagen type Ⅰ alpha1 chain (COL1A1), collagen type Ⅰ alpha2 chain (COL1A2), and collagen type Ⅵ alpha 6 chain (COL6A6) were the key genes of pathway; the downregulated DEGs were mainly enriched in Staphylococcus aureus infection, Toll-like receptor signaling pathway and leukocyte transendothelial migration pathways, interleukin (IL)-1β, C-X-C motif chemokine ligand 8 (CXCL8), IL-10, matrix metalloproteinase (MMP)1, and MMP9 were the key genes of pathway. The hub core genes of the PPI network were formyl peptide receptor (FPR)1, FPR2, IL-1β, IL-10, and CXCL8.ConclusionsThe results of this study indicate that the genes and signaling pathways involved in COL1A1, COL1A2, COL6A6, IL-1β, CXCL8, IL-10, MMP1, and MMP9 affect the healing of VLU. FPR1, FPR2, IL-1β, IL-10, and CXCL8 can be used as potential therapeutic targets.