Značaj subkutane paratibijalne fasciotomije u lečenju hroničnog venskog ulkusa
Significance of subcutaneous paratibial fasciotomy in the treatment of chronic venous ulcer
Author
Leković, Ivan R.Mentor
Jevtić, MiodragCommittee members
Knežević, MilanMilisavljević, Slobodan


Metadata
Show full item recordAbstract
Hronični venski ulkus spada u najmasovnija oboljenja
čovečanstva i predstavlja jednu od najtežih komplikacija
hronične venske insuficijencije. Lečenje ulkusne bolesti
spada u najkompleksnija lečenja uopšte i često je skopčano
sa veoma neizvesnim uspehom. Preko 30 % pacijenata sa
hroničnim venskim ulkusom se leči duže od 20 godina a
oko 10 % pacijenata duže od 30 godina. Ulkus kruris čini
između 57% i 80 % svih hroničnih ulceracija. Jedan
venski ulkus kruris, koji pod optimalnom flebološkom
terapijom ne pokazuje tendenciju zarastanja ili koji u toku
12 meseci nije zarastao, smatra se rezistentnim na
terapiju. Procenjuje se da u odrasloj populaciji Srbije od
hroničnog venskog ulkusa boluje 1,5 do 2,5 %, što ima
veliki socialno-ekonomski značaj. U lečenju HVU
stadijuma C 5-6 primenjuju se brojne metode kako
konzervativne tako i operativne, shodno etiologiji i
lokalnom nalazu ali postoji velika stopa recidiva kao i
rezistentnost na brojne metode lečenja. Cilj disertacije
je da se kroz pore...đenje klasičnih metoda lečenja
hroničnog venskog ulkusa (HVU) bez primene subkutane
paratibijalne fasciotomije (SPTF) sa klasičnim
metodama lečenja HVU uz primenu SPTF, odredi značaj subkutane paratibijalne fasciotomije za lečenje HVU. U
istraživanje je uključeno ukupno 100 bolesnika kod kojih je
lečenje hroničnog venskog ulkusa sprovedeno klasičnim
metodama lečenja tog obolenja . Prvu grupu je sačinjavalo
50 bolesnika kod kojih je klasično lečenje sprovedeno uz
dodatnu primenu subkutane paratibijalne fasciotomije, a
drugu grupu 50 bolesnika kod kojih je klasično lečenje
sprovedeno bez primene subkutane paratibijalne
fasciotomije. Perioperativno i postoperativno su kod
svih praćeni prethodno postavljeni parametri, klinički
tok , pojava komplikacija lečenja HVU, kao i dužina
zarastanja HVU, pritisci u mišićnim odeljcima
potkolenice sa ulkusom kao i vrednosti transkutanog
pritiska kiseonika potkolenice sa ulkusom.
Dobijeni rezultati su uz klinički aspekt, potvrdili da
kod bolesnika kod kojih je klasično lečenje hroničnog
venskog ulkusa sprovedeno uz primenu subkutane
paratibijalne fasciotomije, dolazi do bržeg zarastanja
ulkusa, da je manja stopa recidiva i da subkutana
paratibijalna fasciotomija dovodi do značajnog pada
pritiska u mišićnim kompartmentima i porasta
transkutanog parcijalnog pritiska kiseonika.
Ova studija je pokazala da je primena SPTF u lečenju HVU
sigurna, pouzdana i efikasna procedura koja nije praćena
komplikacijama kako intraoperativnio, tako ni
postoperativno. Primena SPTF ubrzava zatvaranje
ulkusa, smanjuje stopu recidiva i omogućava poboljšanje
lokalne mikrocirkulacije u pogođenoj regiji čime se
rešava jedan od brojnih faktora smetnje zarastanja
ulkusa-hronična ishemija usled hroničnog
fasciokompresivnog sindroma, popravlja se
mikrocirkulacija u pogođenoj regiji, što sve ukupno
povoljno utiče na njegovo zarastanje. Sam operativni akt
je bezbedan, ne zahteva posebnu aparaturu niti specijalnu
obuku hirurškog tima, te kao takav je primenjiv kod
najvećeg broja pacijenata sa ulkus krurisom koji su
kandidati za operativno lečenje.
Chronic venous ulcer is one of the most widespread diseases
of mankind and is one of the most serious complications of
chronic venous insufficiency. Treatment of venous ulcer is one
of the most complex treatment in general and is often coupled
with very uncertain success. Over 30% of patients with chronic
venous ulcer is treated with more than 20 years and about 10%
of patients over 30 years. Venous ulcer makes between 57%
and 80% of all chronic ulcers. A venous ulcer cruris, which
under optimal therapy shows no tendency to heal or for 12
months is not healed, it is resistant to therapy. It is estimated
that in the adult population of Serbia with chronic venous
ulceration affects 1.5 to 2.5%, which is of great socio-economic
importance. In the treatment of stage C 5-6 venous ulcer, there
are numerous methods of conservative and operative,
according to the etiology and local findings, but there is a high
recurrence rate and resistance to a number of methods of
treatment. The aim of the ...dissertation is to compare the
conventional methods of treatment of chronic venous ulcers
without the use of subcutaneous paratibial fasciotomy (SPTF)
with conventional methods of treatment, using SPTF,
determine the importance of subcutaneous paratibial
fasciotomy for the treatment of chronic venous ulcer. The study
included a total of 100 patients the treatment of chronic venous
ulcers conducted by classical methods of treatment of this
disease. The first group consisted of 50 patients in whom conventional treatment was conducted with the additional use
of subcutaneous paratibial fasciotomy, a second group of 50
patients in whom conventional treatment is conducted without
the use of subcutaneous paratibial fasciotomy. Perioperative
and postoperative were monitored in all pre-set parameters,
clinical course, occurrence of complications of treatment
chronic venous ulcer and chronic venous ulcer healing length,
the pressure in muscle compartments of the lower leg with
ulcers as well as the value of transcutaneous oxygen pressure
with a lower leg ulcer. The results obtained with the clinical
aspect, confirmed that in patients in whom conventional
treatment of chronic venous ulcers conducted with the use of
subcutaneous paratibial fasciotomy, coming in faster healing of
ulcers, the lower recurrence rate and subcutaneous paratibial
fasciotomy leads to a significant drop in pressure in the muscle
compartments and an increase in transcutaneous partial
pressure of oxygen.
This study has shown that the use SPTF for the treatment of
chronic venous ulcers secure, reliable and effective procedure
that is not accompanied by complications that intraoperatively,
nor postoperatively. Application SPTF accelerates ulcer
closure, reduces relapse rate and to improve local
microcirculation in the affected region, which solves one of the
many factors interfere ulcer-healing chronic ischemia due to
chronic fasciokompresywe syndrome, improves the
microcirculation in the affected region, the total of all its positive
effect on healing . I act is operating safely, without any special
apparatus or special training of the surgical team, and as such
is applicable in most patients with chronic venous ulcer who are
candidates for surgical treatment .