激光灼闭与剥脱术治疗大隐静脉曲张患者的随机对照研究

A random, comparative study on endovenous laser therapy and saphenous veins stripping for the treatment of great saphenous vein incompetence

目的评价大隐静脉曲张的激光灼闭术(EVLT)和传统剥脱术的治疗效果。方法80例(80条肢体)大隐静脉曲张患者随机分成两组,EVLT 组行大隐静脉 EVLT 术,静脉剥脱组行传统大隐静脉高位结扎剥脱术。比较两组的手术时间、出血量、并发症、疼痛程度、平均住院日及术后6和12个月血管多普勒超声和空气体积扫描复查结果。结果 EVLT 组在术中出血量(P<0.01)、住院日(P<0.05)和术后疼痛程度(P<0.05)上均较静脉剥脱组显著减少。但两组患者手术时间和总并发症发生率上差异均无统计学意义(P>0.05)。EVLT 组2例术后早期大隐静脉内细小血流,剥脱组3例在小腿段探及大隐静脉内血流,两组患肢术后的静脉容积(P<0.05)、静脉灌注指数(P<0.01)和剩余容积分数(P<0.01)均较术前显著减少,但两组之间比较差异无统计学意义(P>0.05)。结论EVLT 是一种安全有效的大隐静脉曲张的微创手术方法,近期疗效与传统大隐静脉高位结扎和剥脱术相似。

Objective To evaluate the therapeutic effects of endovenous laser therapy （EVLT） and saphenous veins stripping in the treatment of great saphenous vein incompetence. Methods Eighty cases （80 limbs） with great incompetent saphenous vein were randomly divided into 2 equal groups：EVLT group and stripping group. The patients in the EVLT group underwent EVLT and those in the stripping group underwent upper ligation and stripping of great saphenous vein. The duration of operation, blood losing, complications, pain grade, and hospitalization time were compared. All eases were followed up for 6 months and 12 months using Doppler sonography and air Plethysmography. Results The blood losing （ P 〈 0.01 ）, hospitalization time （P 〈 0.05 ） and pain grade （P 〈 0.05 ）in the EVLT group were all significantly less than those in the stripping group, while the operation duration and complication were not significantly different between the two groups （ P 〉 0.05 ）. All patients in both groups got improvements of venous volumn （ P 〈 0.05 ）, Venous Filling Index （ P 〈0.01 ）, and residual Venous Fraction （ P 〈 0.01 ）, yet there were no statistical differences between the two groups（ P 〉 0.05）. Conclusion Endovenous laser therapy is a safe, effective, minimal invasive procedure for the patients with great saphenous vein incompetence. Its short-time efficiecy is similar to that of the traditional upper ligation and laceration of greater saphenous vein.