腔镜深筋膜下交通静脉离断术联合腔内激光术治疗大隐静脉曲张的效果评价  

Effect evaluation of subfascial endoscopic perforator surgery combined with endovenous laser treatment in the treatment of great saphenous varicose veins

作　　者：汪立[1] 张弘[1] 杜建青[1] 吴忠隐 李荣华[1] 张青云[1] 陈磊[1] Wang Li;Zhang Hong;Du Jianqing;Wu Zhongyin;Li Ronghua;Zhang Qingyun;Chen Lei(Department of Vascular Surgery and General Surgery,Affiliated Hospital of Chengde Medical University,Chengde 067000,China)

机构地区：[1]承德医学院附属医院血管普外科,河北承德067000

出　　处：《中国血管外科杂志（电子版）》2022年第2期167-171,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：承德市科学技术研究与发展计划项目(201904A049)。

摘　　要：目的探讨腔镜深筋膜下交通静脉离断术(subfascial endoscopic perforator surgery,SEPS)联合静脉腔内激光术(endovenous laser treatment,EVLT)在大隐静脉曲张的治疗效果。方法将2019年1月至2021年1月承德医学院附属医院收治的98例大隐静脉曲张患者随机分为观察组和对照组,每组49例,对照组采取大隐静脉高位结扎剥脱术治疗,观察组采取SEPS联合EVLT治疗。比较两组的手术结果、临床疗效、血液流变学和血清Krüppel样转录因子2(Krüppel-like factor 2,KLF2)、serpine1水平。结果观察组和对照组的总有效率分别为93.88%(46/49)和83.67%(41/49),差异无统计学意义(P=0.110)。观察组手术时间、住院时间均短于对照组,术中出血量、术后3 d的疼痛评分均低于对照组(P<0.001)。观察组并发症发生率为10.20%(5/49),低于对照组的28.57%(14/49),差异有统计学意义(P=0.022)。观察组术后1、3 d的血浆黏度、全血黏度、红细胞比容和serpine1水平均低于对照组,KLF2水平高于对照组,差异均有统计学意义(P<0.05)。结论SEPS联合EVLT治疗大隐静脉曲张患者安全可靠、并发症少、复发风险低,近期疗效满意,值得临床推广应用。Objective To evaluate the clinical effect of subfascial endoscopic perforator surgery(SEPS)combine with endovenous laser treatment(EVLT)in the treatment of great saphenous varicose veins.Methods A total of 98 patients with great saphenous varicose veins who were admitted to the Affiliated Hospital of Chengde Medical College from January 2019 to January 2021 were randomly divided into observation group and control group,with 49 cases in each group.The control group was treated with high ligation and stripping of the great saphenous veins,while the observation group was treated with SEPS combined with EVLT.The surgical results,clinical efficacy,hemorheology and levels of serum Krüppel-like factor 2(KLF2)and serpine1 were compared between the two groups.Results The total effective rates of observation group and control group were 93.88%(46/49)and 83.67%(41/49),respectively,and the difference was not statistically significant(P=0.110).The operation time and hospital stay of observation group were shorter than those of control group,and the intraoperative blood loss and the pain score three days after the operation were lower than those of control group(all P<0.001).The incidence of complications in observation group was 10.20%(5/49),which was lower than that of control group[28.57%(14/49)],and the difference was statistically significant(P=0.022).The plasma viscosity,whole blood viscosity,hematocrit and serpine1 level of observation group were lower than those of control group at 1-and 3-day after operation,and the KLF2 level was higher than that of control group,and the differences were statistically significant(P<0.05).Conclusion SEPS combined with EVLT in the treatment of great saphenous varicose veins is safe and reliable,with few complications and low recurrence risk.The short-term efficacy is satisfactory,and it is worthy of clinical promotion.

关 键 词：静脉曲张 大隐静脉 血液流变学 并发症 腔镜深筋膜下交通静脉离断术 静脉腔内激光术 

分 类 号：R654.4[医药卫生—外科学]