腔内激光治疗术联合腔镜深筋膜下交通静脉离断术治疗原发性下肢静脉曲张的效果  

CLINICAL EFFECT OF ENDOVENOUS LASER THERAPY COMBINED WITH SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY VERSUS HIGH LIGATION AND STRIPPING OF THE GREAT SAPHENOUS VEIN IN TREATMENT OF PRIMARY VARICOSE VEIN OF THE LOWER EXTREMITIES

作　　者：冯秀利 郭源[1] FENG Xiuli;GUO Yuan(Hepatobiliary Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266100, China)

机构地区：[1]青岛大学附属医院肝胆外科,山东青岛266100 [2]山东省昌乐县人民医院血管外科

出　　处：《精准医学杂志》2020年第2期169-171,175,共4页Journal of Precision Medicine

摘　　要：目的比较静脉腔内激光治疗术(EVLT)联合腔镜深筋膜下交通静脉离断术(SEPS)与大隐静脉高位结扎剥脱术治疗原发性下肢静脉曲张(PVV)的效果。方法回顾性分析2015年12月—2018年1月昌乐县人民医院血管外科收治的临床病因解剖病理(CEAP)分级C3~C6级的122例PVV患者(152条患肢)的临床资料,依据治疗方法分为EVLT联合SEPS组(微创组)和大隐静脉高位结扎剥脱术组(对照组),对两组患者的术中及术后情况和并发症发生情况进行比较。结果微创组手术后CEAP分级较术前明显改善(Z=10.450,P<0.05),对照组手术后CEAP分级较术前明显改善(Z=10.309,P<0.05),但两组患者术前与术后CEAP分级比较差异无显著性(P>0.05)。微创组手术时间、住院时间、术中出血量、术后VCSS、术后VAS评分等指标与对照组比较差异均有显著性(t=-13.375、-3.560,Z=-4.421^-2.580,P<0.05);对照组患者皮下血肿的发生率显著高于微创组(χ^2=4.989,P<0.05);微创组术后浅静脉炎的发生率显著高于对照组(χ^2=6.057,P<0.05)。结论两种手术方式均是治疗PVV有效的手段,但EVLT联合SEPS术式具有患者创伤小、术后恢复快等优点。Objective To investigate the clinical effect of endovenous laser treatment(EVLT)combined with subfascial endoscopic perforator surgery(SEPS)versus high ligation and stripping of the great saphenous vein in the treatment of primary varicose vein(PVV)of lower extremities.Methods A retrospective analysis was performed for the clinical data of 122 patients(152 affected limbs)with clinical-etiology-anatomy-pathophysiology(CEAP)grade C3-C6 PVV who were admitted to Department of Vascular Surgery,The People’s Hospital of Changle County,from December 2015 to January 2018,and according to the treatment method,they were divided into minimally invasive surgery group(SEPS+EVLT)and control group(high ligation and stripping of the great saphenous vein).The two groups were compared in terms of intraoperative and postoperative conditions and complications.Results The minimally invasive surgery group had a significant improvement in CEAP grade after surgery(Z=10.450,P<0.05),and the control group also had a significant improvement in CEAP grade(Z=10.309,P<0.05),but there was no significant difference in CEAP grade between the two groups before and after surgery(P>0.05).There were significant differences between the minimally invasive surgery group and the control group in time of operation,length of hospital stay,intraoperative blood loss,postoperative venous clinical severity score,and postoperative Visual Analogue Scale score(t=-13.375,-3.560,Z=-4.421--2.580,P<0.05).The control group had a significantly higher incidence rate of subcutaneous hematoma than the minimally invasive surgery group(χ^2=4.989,P<0.05),and the minimally invasive surgery group had a significantly higher incidence rate of superficial phlebitis than the control group after surgery(χ^2=6.057,P<0.05).Conclusion Both surgical procedures are safe and effective in the treatment of PVV.However,EVLT combined with SEPS has the advantages of little trauma and fast recovery after surgery.

关 键 词：静脉曲张 腔镜深筋膜下交通静脉离断术 血管外科手术 大隐静脉高位结扎剥脱术 激光疗法 疗效比较研究 手术后并发症 

分 类 号：R543.6[医药卫生—心血管疾病] R654.3[医药卫生—内科学]