腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗下肢静脉性溃疡的疗效观察

Effect of endovenous laser treatment combined with ultrasound-guided foam sclerosing agent injection in the treatment of venous leg ulcer

目的探讨腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗下肢静脉性溃疡(VLU)的疗效。方法收集2016年1月至2018年1月巴彦淖尔市医院治疗的180例VLU患者临床资料。根据治疗方式不同分为腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗作为激光组(n=90);大隐静脉曲张高位结扎联合超声引导下泡沫硬化剂注射治疗作为结扎组(n=90)。统计并比较两组患者手术指标(手术时间、住院时间和手术出血量)、溃疡愈合率、溃疡愈合时间、并发症发生率,以及术后2年溃疡复发率和复发时间。比较术前、术后1个月和术后2个月两组患者静脉临床严重程度评分(VCSS)和溃疡面积。结果激光组患者手术时间、住院时间和溃疡愈合时间均短于结扎组,手术出血量少于结扎组患者,差异有统计学意义(P<0.05);术后1个月和2个月,激光组患者VCSS评分低于结扎组患者,溃疡面积小于结扎组患者,差异有统计学意义(P<0.05);两组患者溃疡愈合率和并发症发生率比较,差异无统计学意义(P>0.05);术后2年,所有溃疡愈合患者中,激光组的溃疡复发率低于结扎组患者,差异无统计学意义(P>0.05)。结论腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗VLU患者可较好促进溃疡面愈合,缓解临床症状,并降低手术操作难度。

Objective To investigate the clinical efficacy of endovenous laser treatment(EVLT)combined with ultrasound-guided foam sclerosing agent injection in the treatment of venous leg ulcers(VLU).Method A total of 180 VLU patients treated in Bayannaoer Hospital from January 2016 to January 2018 were selected,and their clinical data were collected.According to the varying treatment methods,all subjects were divided into a laser group(n=90)as laser group was treated with EVLT combined with ultrasound-guided foam sclerosing agent injection treatment(n=90),and those who received great saphenous vein high ligation combined with ultrasound-guided foam sclerosing agent injection treatment were definite as ligation group(n=90).The two groups of patients’surgical indicators(operating time,hospitalization time,surgical blood loss),ulcer healing rate,ulcer healing time,complication rate,ulcer recurrence rate,and recurrence time two years after surgery were recorded and compared.The venous clinical severity score(VCSS)and ulcer area were compared between the two groups before the operation,one month after the operation,and two months after the operation.Result The operation time,hospitalization time,and ulcer healing time of the laser group was shorter than those of the ligation group;the blood loss during the operation was less than that of the ligation group,and the difference was statistically significant(P<0.05);1 month and two months after the operation,the VCSS score of the patients in the laser group was lower than that of the patients in the ligation group,and the ulcer area was smaller than that of the patients in the ligation group.The difference was statistically significant(P<0.05);the difference in ulcer healing rate and complication rate between the two groups was not statistically significant(P>0.05).2 years after the operation,among all the ulcer healing patients,the ulcer recurrence rate in the laser group was lower than that in the ligation group,the difference was not statistically significant(P>0.05).Conclusion EVLT combined with ultrasound-guided foam sclerotherapy agent injection for VLU patients could better promote the healing of the ulcer surface,relieve the clinical symptoms and reduce the operation’s difficulty.