静脉腔内激光闭合术和内镜深筋膜下穿通静脉离断术治疗下肢静脉曲张伴病理性穿通静脉功能不全的临床效果研究  

Clinical study on the eff ects of endovenous laser ablation and subfascial endoscopic perforator surgery in the treatment of lower limb varicose veins with pathological portal vein dysfunction

作　　者：于家祥[1] 姜俊义 Yu Jiaxiang;Jiang Junyi(General Surgery Department of Dunhua Hospital,Jilin Dunhua 133700,China)

机构地区：[1]敦化市医院普外科,吉林敦化133700

出　　处：《临床普外科电子杂志》2024年第3期36-40,共5页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的观察静脉腔内激光闭合术(endovenous laser ablation,EVLA)和内镜深筋膜下穿通静脉离断术(subfascial endoscopic perforator surgery,SEPS)治疗下肢静脉曲张伴病理性穿通静脉功能不全的临床效果。方法选取2021年4月至2024年3月敦化市医院诊治的83例下肢静脉曲张伴病理性穿通静脉功能不全患者,根据治疗方式不同分为EVLA组(n=42)、SEPS组(n=41)。对比两组患者手术相关指标、疼痛程度、应激反应、生活质量。结果EVLA组患者的手术用时、切口长度、住院时长、术后卧床时长均短于SEPS组,术中失血量少于SEPS组,差异均有显著性(P<0.05)。两组患者术后的并发症发生率无显著差异(P>0.05)。术后3、12、24、48h,EVLA组患者的NRS评分均低于SEPS组,差异均有显著性(P<0.05)。术前,两组患者的皮质醇及肾上腺素水平无显著差异(P>0.05)。术后2d,两组患者的皮质醇、肾上腺素水平较术前升高,且EVLA组的皮质醇及肾上腺素水平低于SEPS组,差异均有显著性(P<0.05)。术前,两组患者的慢性静脉功能不全问卷(chronic venous insuffi ciency questionnaire,CIVIQ)评分无显著差异(P>0.05)。术后3个月,两组患者的CIVIQ评分较术前均升高,EVLA组的CIVIQ评分高于SEPS组,差异有显著性(P<0.05)。结论对于下肢静脉曲张伴病理性穿通静脉功能不全的患者,EVLA、SEPS在降低并发症发生率方面效果相似,但EVLA可缩短患者康复时间,减轻患者应激反应与机体疼痛感,并提高患者的生活质量。Objective To observe the clinical effi cacy of endovenous laser ablation(EVLA)and endoscopic submucosal perforator surgery(SEPS)in the treatment of lower limb varicose veins with pathological perforating venous insuffi ciency.Method 83 patients with lower limb varicose veins accompanied by pathological perforating venous insuffi ciency treated in Dunhua City Hospital from April 2021 to March 2024 were selected and divided into EVLA group(n=42)and SEPS group(n=41)according to diff erent treatment methods.Compare the surgical related indicators,pain level,stress response,and quality of life between two groups of patients.Result The surgical time,incision length,hospitalization time,and postoperative bed rest time of patients in the EVLA group were shorter than those in the SEPS group,and the intraoperative blood loss was less than that in the SEPS group,with significant differences(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups of patients(P>0.05).At 3,12,24,and 48 hours postoperatively,the NRS scores of patients in the EVLA group were signifi cantly lower than those in the SEPS group(P<0.05).Before surgery,there was no signifi cant diff erence in cortisol and adrenaline levels between the two groups of patients(P>0.05).Two days after surgery,the levels of cortisol and adrenaline in both groups of patients increased compared to preoperative levels,and the cortisol and adrenaline levels in the EVLA group were lower than those in the SEPS group,with signifi cant diff erences(P<0.05).Before surgery,there was no signifi cant diff erence in CIVIQ scores between the two groups of patients(P>0.05).Three months after surgery,the CIVIQ scores of both groups of patients increased compared to preoperative levels.The CIVIQ score of the EVLA group was higher than that of the SEPS group,and the diff erence was signifi cant(P<0.05).Conclusion For patients with lower limb varicose veins accompanied by pathological perforating dysfunction,EVLA and SEPS have similar

关 键 词：静脉腔内激光闭合术 内镜深筋膜下穿通静脉离断术 下肢静脉曲张 病理性穿通静脉功能不全 疼痛程度 应激反应 

分 类 号：R654.4[医药卫生—外科学]