【摘要】 目的 觀察綜合治療體表血管瘤及脈管畸形的臨床療效。 方法 2008年1月-2010年9月，收治體表血管瘤和脈管畸形患者共205例。手術治療156例，其中單純手術治療103例，合并介入治療9例，硬化劑治療44例；非手術治療49例，其中介入治療1例，硬化劑治療38例，介入合并硬化劑治療10例。術后隨訪6個月～3年。 結果 15例手術治療患者于術后6個月～2年復發，其中單純手術治療患者10例（復發率9.71%），合并介入治療患者2例（復發率22.22%），合并硬化劑治療患者3例（復發率6.82%），均再次手術治療后痊愈。9例非手術治療患者于治療后3個月～2年復發，其中8例硬化劑治療患者，1例介入合并硬化劑治療患者，均經手術治療后痊愈。余患者未見復發。 結論 以手術治療為主的綜合治療，是體表血管瘤和脈管畸形治療的良好方法。【Abstract】 Objective To observe the clinical therapeutic efficacy of comprehensive treatment on body surface hemangioma and vascular malformations. Methods Between January 2008 and September 2010, 205 pateints with surface hemangioma and vascular malformation were treated. A total of 156 patients received surgical treatment, in whom 103 received surgery alone, 9 underwent combined interventional treatment, and 44 received combined sclerotherapy. There were 49 patients underwent non-surgical treatment, including intervention in 1, sclerotherapy in 38 involving 10 had combined sclerotherapy. The patients were followed up for 6 months to 3 years. Results A total of 15 patients who had received surgical treatment recurred 6 months to 2 years after the treatment, including 10 who had been treated with surgery alone (with the recurrence rate of 9.71%), 2 combined with interventional treatment (with the recurrence rate of 22.22%), and 3 combined with sclerotherapy (with the recurrence rate of 6.82%). They were all cured after reoperation. Nine cases of non-surgical treatment recurred 3 months to 2 years after the treatment, including 8 who had received sclerotherapy, and 1 combined with interventional treatment and sclerotherapy. Patients were all cured after surgery. The other patients had no recurrence. Conclusion Applying mainly on surgical treatment, the combined therapy is a good way for body surface hemangioma and vascular malformations.
目的探討帶闊筋膜游離股前外側皮瓣（anterolateral thigh flap，ALTF）修復糖尿病足潰瘍（diabetic foot ulcers，DFUs）伴骨外露的療效。方法2019年1月—2021年1月，收治20例DFUs伴骨外露患者。男17 例，女3例；年齡48～76 歲，中位年齡57.5歲。糖尿病足Wagner分級3級10例，4級10例。足部潰瘍形成時間1～14個月，中位時間3個月。CT血管造影檢查示患者均存在雙下肢動脈粥樣硬化表現；其中6例嚴重狹窄或閉塞，行經皮血管腔內成形術。入院后一期徹底清創聯合封閉式負壓引流處理，清創后創面范圍為7 cm×6 cm～27 cm×10 cm；二期采用帶闊筋膜游離ALTF修復創面及部分缺損肌腱，皮瓣切取范圍為8 cm×5 cm～28 cm×11 cm。供區創面直接縫合。記錄皮瓣成活情況、創面愈合時間以及并發癥發生情況。術后2周及6個月使用激光散斑血流成像系統檢測皮瓣及其周圍皮膚血流灌注情況。術后6個月以美國矯形足踝協會（AOFAS）評分評價足部功能。結果 術后6例出現皮瓣下積液，對癥處理后愈合。最終14例皮瓣完全成活；3例皮瓣邊緣部分壞死，經換藥后愈合；3例皮瓣出現靜脈危象，探查后1例皮瓣完全壞死，另2例皮瓣部分成活，經清創換藥后植皮修復。皮瓣成活率95.0%，保肢率100%。皮瓣移植術后創面愈合時間14～30 d，平均19.1 d。2例患者愈合后1個月內再發皮瓣外周皮膚潰瘍，經換藥后愈合。供區切口18例Ⅰ期愈合；2例局部皮膚壞死，經清創縫合后愈合。患者均獲隨訪，隨訪時間6～30個月，中位時間11個月。皮瓣質地、外觀及彈性良好。患者均能獨自行走，無行走時疼痛。術后6個月13例門診隨訪患者AOFAS評分為（75.9±11.9）分，與術前（44.7±18.4）分比較差異有統計學意義（t=?7.025，P=0.000）；患者皮瓣外周正常皮膚血流灌注值由術后2周（38.1±7.8）PU升高至（42.7±10.3）PU，差異有統計學意義（t=?4.680，P=0.001）。結論帶闊筋膜ALTF血供豐富、成活率高，可用于修復DFUs伴骨外露創面。皮瓣愈合后可促進患足血運重建，降低潰瘍復發風險，避免截肢。