改良大隐静脉高位结扎剥脱术治疗原发性大隐静脉曲张的临床效果  

Clinical effect of improved high ligation and stripping of great saphenous vein in the treatment of primary great saphenous vein varicose

作　　者：闫昌葆 刘大方 张杰[1] 赵辉 耿佩强[1] 王艳阳 顾纵横 赵亮[1] Yan Changbao;Liu Dafang;Zhang Jie;Zhao Hui;Geng Peiqiang;Wang Yanyang;Gu Zongheng;Zhao Liang(Department of Vascular Surgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院血管外科,北京101100

出　　处：《血管与腔内血管外科杂志》2021年第1期42-46,共5页Journal of Vascular and Endovascular Surgery

基　　金：潞河医院首都临床特色应用研究项目培育专项建设(KJ2018CX009-41)。

摘　　要：目的评价改良大隐静脉高位结扎剥脱术治疗原发性大隐静脉曲张的临床效果及安全性。方法选取2019年1月至2019年6月首都医科大学附属北京潞河医院收治的89例原发性大隐静脉曲张患者临床资料,根据手术方法的不同将患者分为传统手术组(n=44)和改良手术组(n=45)。两组患者均行单侧大隐静脉高位结扎剥脱术,传统手术组分别结扎大隐静脉股内侧浅静脉、股外侧浅静脉、阴部外侧浅静脉、旋髂浅静脉及腹壁浅静脉5个属支,改良手术组只结扎股外侧浅静脉和股内侧浅静脉。两组患者均随访1年,比较两组患者的手术时间、术中出血量及术后并发症发生率,记录术前、术后1个月和术后1年两组患者的静脉临床严重程度评分(VCSS)以及股隐静脉处反流情况。并针对不同性别和临床、病因、解剖学、病理生理(CEAP)分级的患者进行亚组分析。结果改良手术组患者的手术时间短于传统手术组,术中出血量少于传统手术组,并发症发生率低于传统手术组,差异均有统计学意义(P<0.05)。术后1个月和术后1年,两组患者的VCSS评分均小于本组术前(P<0.05);术前、术后1个月、术后1年,两组患者的VCSS评分比较,差异均无统计学意义(P>0.05);两组患者术后1年改善评分比较,差异无统计学意义(P>0.05)。随访1年两组患者的反流率比较,差异无统计学意义(P>0.05)。传统手术组中男性患者的并发症发生率高于改良手术组,CEAP分级为C2/C3级患者的并发症发生率高于改良手术组,差异均有统计学意义(P<0.05)。结论改良大隐静脉高位结扎剥脱术治疗原发性大隐静脉曲张效果良好且安全。Objective To evaluate the clinical efficacy and safety of improved high ligation and stripping of great saphenous vein in the treatment of primary great saphenous vein varicose.Method Patients with primary great saphenous vein varicos in Beijing Luhe Hospital,Capital Medical University from January 2019 to June 2019 were selected as traditional surgery group(n=44)and modified surgery group(n=45),respectively.Two groups of patients were treated with unilateral high ligation and stripping of great saphenous vein.The traditional surgery group was treated with ligation of medial femoral superficial vein,lateral femoral superficial vein,lateral pudendal superficial vein,superficial circumflex iliac vein and superficial abdominal vein.The modified surgery group was treated with ligation of lateral femoral superficial vein and medial femoral superficial vein.Both groups were followed up for 1 year.The operation time,intraoperative blood loss and incidence of postoperative complications of the two groups were compared.The venous clinical severity score(VCSS)and femoral saphenous vein reflux of the two groups were recorded before surgery,1 month and 1 year after surgery.Subgroups of patients with different gender and clinical etiology anatomy pathophysiology(CEAP)grading were analyzed.Result The operation time of the modified surgery group was shorter than that of the traditional surgery group,the intraoperative blood loss was less than that of the traditional surgery group,and the incidence of complications was lower than that of the traditional surgery group(P<0.05).The VCSS at 1 month and 1 year after surgery was less than that before surgery(P<0.05).There was no significant difference in VCSS between the two groups before surgery,1 month after surgery and 1 year after surgery(P<0.05).There was no significant difference in improvement score between the two groups at 1 year after surgery(P>0.05).There was no significant difference in reflux rate between the two groups after 1-year follow-up(P>0.05).The complication rate

关 键 词：原发性大隐静脉曲张 改良手术 高位结扎剥脱术 

分 类 号：R543.6[医药卫生—心血管疾病]