大隐静脉曲张传统手术与腔镜下小腿交通静脉断离术的临床对比研究

Clinical comparative study on conventional surgical and subfascial endoscopic perforator surgery in great venous varicosity

目的对比研究传统大隐静脉高位结扎加分段剥脱术和腔镜下小腿交通静脉断离加大隐静脉内翻式点状抽剥术的疗效。方法研究组42例采用腔镜下交通静脉断离加大隐静脉内翻式点状抽剥术,对照组42例行传统手术。比较两组手术时间、术中出血量、术后开始下床活动时间、住院天数、疼痛程度、瘢痕、术后复发及溃疡愈合情况。结果研究组手术时间、术后开始下床活动时间、住院天数均显著低于对照组(P<0.01),溃疡愈合时间、疼痛程度及瘢痕亦明显轻于对照组。术中出血量较对照组差异无统计学意义(P>0.05)。术后没有发生静脉血栓形成、皮肤坏死、下肢功能障碍等严重并发症。患者均痊愈出院。随访4～16个月均无复发,疗效满意。结论腔镜下交通静脉断离加大隐静脉内翻式点状抽剥术治疗大隐静脉曲张的临床综合疗效明显优于传统手术方法,具有微创、瘢痕小、疼痛轻、住院时间短、无复发及溃疡愈合快等优点。

Objective To compare the curative effect of high ligation ＋ exfoliation and subfascial endoscopic perforator surgery（SEPS） for superficial varicose veins in calf ＋ invagination spot-striping surgery in great venous varicosity. Methods Study group （42 patients） accepted SEPS ＋ invagination spot-striping surgery and control group （42 patients） accepted traditional surgeries. Operation duration, bleeding volume in operation, the time of beginning movement away from bed after operation, hospitalization duration, the degree of pain, the scar, the recrudescence after operation and the instance of the ulcer heals of two groups were compared. Results Operation duration, bleeding volume in operation, the time of begin movement away from bed after operation and hospitalization durations of study group were significantly lower than those of control group（ P〈0.01）. The time of the ulcer heals are lower than those of control group in evidence. The patients in study group had markedly lighter ache and fewer scars than those in control group, bleeding volume in operation was no difference than those of control group（ P 〉 0.05）. All of the patients in study group recovered without severe syndromes such as venous thrombosis, skin necrosis, lower limb functional disorder etc. They had no recrudesce after 4-16 months and were satisfied with the curative effect. Conclusions The clinical curative effect of SEPS ＋ invagination Spot-striping surgery in great venous varicosity is superior to that of traditional operation and it has the advantages such as minor wound, few scars, light pains,short hospi-talization duration, without recrudescence, the ulcer heals quickly and so on.