激光腔内闭合术对大隐静脉曲张的疗效

Efficacy of endovenous laser treatment for varicose great saphenous vein

目的探讨激光腔内闭合术(EVLT)对大隐静脉曲张的疗效。方法收集2018年1月至2020年3月首都医科大学大兴教学医院收治的大隐静脉曲张患者的临床资料,根据治疗方式的不同将其分为手术组(采用高位结扎剥脱术治疗)和激光组(采用EVLT治疗),每组49例。比较两组患者的手术指标,包括切口总长度、手术用时、术中出血量。比较两组患者的术后恢复指标,包括术后疼痛程度、出院时间、患肢酸胀感、患肢沉重麻木感消失时间及术后并发症发生率。比较两组患者术后6个月的病情和大隐静脉功能改善情况,术后12个月的复发率、色素沉着消退率和浅表溃疡愈合率。结果激光组患者的切口总长度、手术用时均短于手术组患者,术中出血量少于手术组患者(P<0.05)。术后,激光组患者的VAS评分低于手术组患者,出院时间、患肢酸胀感消失时间、患肢沉重麻木感消失时间均短于手术组患者(P<0.05)。激光组患者的术后并发症总发生率低于手术组患者(P<0.05)。术后6个月,激光组患者的静脉临床严重程度评分(VCSS)低于手术组患者,慢性静脉功能不全问卷(CIVIQ)评分高于手术组患者(P<0.05)。术后12个月,两组患者的复发率、患肢色素沉着消退率、患肢浅表溃疡愈合率比较,差异均无统计学意义(P>0.05)。结论激光腔内闭合术治疗大隐静脉曲张患者的远期疗效可达到传统手术的治疗效果,且具有术中出血量少、患者痛苦小、术后恢复快等优势。

Objective To explore the efficacy of endovenous laser treatment(EVLT)for varicose great saphenous vein.Method Clinical data of patients with varicose great saphenous vein admitted to Capital Medical University Daxing Teaching Hospital from January 2018 to March 2020 were collected and the patients were divided into the surgery group(n=49,treated with high ligation and extirpation)and the laser group(n=49,treated with EVLT)based on the treatment methods.The surgical indicators(total incision length,operation time,and intraoperative blood loss),postoperative recovery indicators(postoperative pain degree,discharge time,disappearance time of swelling sensation and heavy numbness of the affected limb),and the incidence of postoperative complications were compared.The severity of the disease,the functional improvement of the great saphenous vein 6 months after surgery and the recurrence rate,pigmentation regression rate and superficial ulcer healing rate 12 months after surgery were compared.Result The total incision length,operation time and intraoperative blood loss in the laser group were lower than those in the surgery group(P<0.05);the postoperative pain VAS score was lower than those in surgery group,hospital discharge time,disappearance time of swelling sensation and heavy numbness of affected limb were shorter than those in surgery group(P<0.05);the total incidence of postoperative complications was lower than that in the surgery group(P<0.05).6 months after surgery,the venous clinical severity score(VCSS)was lower,the score of chronic venous insufficiency questionnaire(CIVIQ)higher than that in the surgery group(P<0.05);12 months after surgery,there were no significant differences in recurrence rate,pigmentation regression rate and superficial ulcer healing rate of affected limb between the two groups(P>0.05).Conclusion Endovenous laser treatment for varicose great saphenous vein can achieve similar long-term effect as traditional surgical treatment with the advantages of less intraoperative bleeding,less pain and quick postoperative recovery.