大隐静脉高位结扎联合聚多卡醇硬化治疗对下肢静脉性溃疡的疗效观察

Efficacy of high ligation of great saphenous vein combined with sclerotherapy using polidocanol foam for varicose ulcer of the lower extremities

目的研究大隐静脉高位结扎联合聚多卡醇硬化治疗下肢静脉性溃疡的效果。方法将2014年1月至2016年5月在我科进行治疗的316例(411腿)下肢静脉性溃疡患者纳入研究。将患者依照随机数字表法分为结扎联合硬化组(n=114,150腿)、硬化剂组(n=89,116腿)、结扎组(n=113,145腿)。结扎联合硬化组患者采用大隐静脉高位结扎联合硬化剂注射,硬化剂组给予局部硬化剂注射,结扎组患者单纯进行大隐静脉高位结扎。于术前及术后12个月,由患者填写阿伯丁静脉曲张问卷(aberdeen varicose vein questionnaire,AVVQ)对其生活质量进行评估,由上级医师采用静脉临床严重程度评分表(venous clinical severity,VCSS)对患者静脉曲张及溃疡情况进行评价。记录溃疡术后所需愈合时间,测量溃疡面积,统计治疗1、3个月及6个月后溃疡治愈情况。结果术后12个月3组AVVQ及VCSS评分均较术前降低,结扎联合硬化组患者术后两项评分较另两组更低,差异具有统计学意义(P<0.05)。结扎联合硬化组患者溃疡愈合时间为(26.87±12.60)d,低于硬化剂组的(32.75±14.84)d及结扎组的(30.36±13.47)d,差异具有统计学意义(t=2.016,P=0.045)。3组术后1个月及3个月溃疡与术前相比逐渐缩小(P<0.05),且结扎联合硬化组溃疡相比另两组愈合较快,愈合率较高(P<0.05)。3组患者均无严重并发症发生。结论大隐静脉高位结扎联合聚多卡醇硬化治疗能够有效治愈大隐静脉曲张所致下肢静脉性溃疡;联合治疗在患者生活质量、溃疡愈合速度、不良反应发生率等方面效果优于单纯硬化剂注射法。

Objective To study the therapeutic efficacy of high ligation of great saphenous vein combined with sclerotherapy using polidocanol foam in the treatment of varicose ulcer of the lower extremities. Methods Three-hundred and sixteen patients （401 limbs in total） with varicose ulcer who were treated in our department from January 2014 to May 2016 were enrolled in this study. The patients were randomized into 3 groups： ligation plus sclerotherapy group （LS group, n=114, 150 limbs, treated with high ligation of great saphenous vein combined with sclerotherapy）, sclerotherapy group （S group, n=89, 116 limbs, injected with polidocanol foam）, and ligation group （L group, n=113, 145 limbs treated with high ligation alone）. Patients’ conditions were evaluated using Aberdeen varicose vein questionnaire （AVVQ） and Venous clinical severity （VCSS） before operation and in 12 months after operation. The healing time and ulcerous area were recorded. The healing rate of ulcer at 1, 3 and 6 months after treatment among the groups were compared. Results The AVVQ and VCSS scores were notably decreased at 12 months after treatment （P〈0.05）. The LS group had the lowest scores, which significantly differed from the other 2 groups （P〈0.05）. The median healing time of ulcer was 26.87±12.60 d in the LS group, 32.75±14.84 d in the S group, and 30.36±13.47 d in the L group. The difference was statistically significant （t=2.016,P=0.045）. Also, the ulcer area was gradually shrunk over the time （P〈0.05）. At 1 and 3 months after surgery, the LS group had a higher healing rate than the L and S groups （P〈0.05）. No severe complications occurred. Conclusion High ligation of great saphenous vein combined with sclerotherapy using polidocanol foam is an efficient and safe treatment for varicose ulcer of the lower extremities. Compared with sclerotherapy or high ligation treatment alone, the combination strategy can effectively improve patients’ life quality and promote ulcer healing rate without causing severe complications.