腔镜深筋膜下交通支静脉离断术联合激光闭合术治疗严重大隐静脉曲张效果观察  

Curative effect of subfascial laparoscopic perforator vein surgery combined with endovenous laser closure in treatment of severe great saphenous vein varicosity

作　　者：汪立[1] 张弘[1] 杜建青[1] 吴忠隐 张青云[1] WANG Li;ZHANG Hong;DU Jian-qing;WU Zhong-yin;ZHANG Qing-yun(Department of Vascular Surgery,Affiliated Hospital of Chengde Medical University,Chengde Hebei 067000,China)

机构地区：[1]承德医学院附属医院血管外科,河北承德067000

出　　处：《局解手术学杂志》2021年第6期477-482,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：2019年承德市科学技术研究与发展计划项目(201904A049)。

摘　　要：目的分析腔镜深筋膜下交通支静脉离断术联合激光闭合术在严重大隐静脉曲张患者中的应用效果。方法回顾性分析96例严重大隐静脉曲张患者的临床资料,依据治疗方案的不同将患者分为研究组(n=49)和对照组(n=47)。研究组采取腔镜深筋膜下交通支静脉离断术联合激光闭合术,对照组采取传统大隐静脉高位结扎抽剥术结合交通支静脉结扎术。比较2组患者围术期手术相关指标、切口美观度、临床疗效、复发情况、凝血系统指标水平、手术应激指标水平、下肢静脉病变情况、生活质量。结果研究组手术时间、术后下床活动时间、住院时间均短于对照组,术中出血量少于对照组,手术费用、切口美观度评分高于对照组(P<0.05);2组患者术后深静脉血栓发生率比较差异无统计学意义(P>0.05)。研究组术后1个月总有效率高于对照组(P<0.05)。2组患者术后1 d、3 d的凝血酶原时间(PT)、凝血酶时间(TT)水平较术前降低(P<0.05),组间比较差异均有统计学意义(P<0.05);2组患者术后1 d、3 d的纤维蛋白原(FIB)及血清超敏-C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)水平均较术前升高(P<0.05),组间比较差异均有统计学意义(P<0.05)。术后3、6、12个月,研究组静脉临床严重程度评分(VCSS)、阿伯丁静脉曲张问卷(AVVQ)评分均低于对照组(P<0.05)。2组患者术后3、6个月复发率比较差异无统计学意义(P>0.05),术后12个月研究组复发率低于对照组(P<0.05)。结论腔镜深筋膜下交通支静脉离断术联合激光闭合术治疗严重大隐静脉曲张效果显著,具有创伤小、切口美观、恢复快等优势,可避免机体过度应激及凝血紊乱,且术后不易复发,有利于提升患者生活质量,但手术费用略高。Objective To analyze the application effect of subfascial laparoscopic perforator vein surgery combined with endovenous laser treatment in patients with severe great saphenous vein varicosity.Methods The clinical data of 96 patients with severe great saphenous vein varicosity were retrospectively analyzed,and patients were divided into the study group(n=49)and the control group(n=47)according to the different treatment options.The study group adopted subfascial laparoscopic perforator vein surgery combined with endovenous laser treatment,and the control group adopted traditional high ligation and extraction of great saphenous vein combined with communicating branch vein ligation.The perioperative surgery related indicators,incision aesthetics,clinical efficacy,recurrence,the levels of coagulation system indexes,the levels of surgical stress indicators,venous disease of lower extremities,and the quality of life between the two groups were compared.Results The operation time,postoperative time of getting out of bed,and hospitalization time of the study group were shorter than those of the control group,the amount of blood loss during the operation was less than that of the control group,the cost of surgery and the scores of incision aesthetics were higher than those of the control group(P<0.05).There was no statistically significant difference in the incidence of postoperative deep vein thrombosis between the two groups(P>0.05).The total effective rate in the study group was higher than that in the control group 1 month after operation(P<0.05).The levels of prothrombin time(PT)and thrombin time(TT)of the two groups 1 day and 3 days after operation were lower than those before the operation(P<0.05),and the differences between the two groups were statistically significant(P<0.05).The levels of fibrinogen(FIB)and serum high sensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)of the two groups 1 day and 3 days after operation were higher than those before the operation(P<0.05),and the differences between the two gr

关 键 词：严重大隐静脉曲张 腔镜深筋膜下交通支静脉离断术 激光闭合术 切口美观度 凝血系统 手术应激 术后恢复 复发 

分 类 号：R543.6[医药卫生—心血管疾病]