大隐静脉高位结扎+腔内激光联合点式抽剥术治疗中重度下肢静脉曲张  

Effect of high ligation of great saphenous vein,endovenous laser plus point stripping on moderate and severe varicose veins of lower extremity

作　　者：屠佳 徐茂奇 刘良超 张正林 王亚东 TU Jia;XU Maoqi;LIU Liangchao;ZHANG Zhenglin;WANG Yadong(No.1 Department of General Surgery,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,China)

机构地区：[1]芜湖市中医医院外一科,安徽芜湖241000

出　　处：《皖南医学院学报》2021年第5期455-457,461,共4页Journal of Wannan Medical College

基　　金：芜湖市卫生健康委员会科学和技术项目(201903-27)。

摘　　要：目的:探讨大隐静脉高位结扎+腔内激光联合点式抽剥术对中重度下肢静脉曲张(VVLE)的治疗效果。方法:选取2017年1月~2020年9月芜湖市中医医院收治的105例中重度VVLE患者作为研究对象,随机分为A组(静脉高位结扎+剥脱术,n=35)、B组(静脉高位结扎+剥脱术+激光治疗,n=35)、C组(静脉高位结扎+腔内激光治疗+点式抽剥术,n=35)。比较3组患者的围手术期资料、手术安全性及复发状况。结果:全部患者的静脉曲张相关症状均缓解,A组患者手术时间、术中失血量、术后下床时间、平均住院时间、术后3 d的视觉模拟评分法(VAS)评分高于另外两组,B组术后下床时间、平均住院时间、术后3 d的VAS评分高于C组,差异有统计学意义(P<0.05)。安全性方面,A组肢体肿胀、皮肤感觉麻木、切口愈合不良的发生率高于C组,差异有统计学意义(P<0.05)。患者出院后均进行定期随访,中位随访时间为12.5个月(3~22个月),A、B组分别有2例、1例出现VVLE复发,C组无复发患者,3组复发率比较,差异无统计学意义(P>0.05)。结论:大隐静脉高位结扎+腔内激光联合点式抽剥术对中重度VVLE的疗效显著,手术创伤小,术后恢复快,且安全性较高,值得临床推广应用。Objective:To observe the effect of high ligation of great saphenous vein,endovenous laser combined with point stripping on moderate and severe varicose veins of lower extremity(VVLE).Methods:One hundred and five patients with moderate and severe VVLE admitted to and treated in our hospital were included from January 2017 to September 2020,and randomly divided into group A(high ligation of the vein+stripping,n=35),and group B group(high ligation of the vein+stripping+laser ablation,n=35)and group C(high ligation of the vein+endovenous laser ablation+point stripping,n=35).The three groups were compared concerning the perioperative data,surgical safety and recurrence.Results:Symptoms involved in the varicose veins were significantly relieved in all patients.The operative time,intraoperative blood loss,postoperative ambulation time,average length of hospital stay and visual analogue scale(VAS)score were obviously higher in group A group than in group B and C,yet patients in group B had earlier off-bed activity,shorter average length of hospital stay and lower VAS scores than those in group C(P<0.05).The incidences of limb swelling,skin numbness and poor wound healing were significantly lower in group A than in group C.(P<0.05).All patients were regularly followed after discharge from 3 to 22 months(median:12.5 months),and the follow-up showed that relapse of VVLE occurred in 2 in group A and 1 in group B.There was no recurrence in group C.The difference was insignificant in recurrence rate among three groups(P>0.05).Conclusion:High ligation of great saphenous vein,endovenous laser ablation combined with point stripping can be curative effect for moderate and severe VVLE,and this treatment protocol is worthy of clinical recommendation because of its small surgical trauma,earlier postoperative recovery and high safety.

关 键 词：下肢静脉曲张 腔内激光治疗 高位结扎术 点式抽剥术 

分 类 号：R654.4[医药卫生—外科学]