激光联合大隐静脉高位结扎术治疗原发性下肢静脉曲张的疗效

Efficacy of Laser Treatment Combined with High Ligation of Great Saphenous Vein in Primary Varicose Veins of Lower Extremities

目的探讨激光联合大隐静脉高位结扎术治疗原发性下肢静脉曲张的疗效。方法将291例原发性下肢静脉曲张患者按随机数字表法分成2组:治疗组146例,采用激光联合大隐静脉高位结扎术治疗;对照组145例,单纯采用激光治疗。通过全自动血液流变快测仪测定2组全血黏度低切(10 s-1)、中切(30 s-1)、高切(100 s-1)、血浆黏度(100 s-1)、红细胞压积、纤维蛋白原(g.L-1)。彩色多普勒超声诊断仪检测2组患者收缩期最大血流速度(Vmax)、舒张期最低血流速度(Vmin)、平均血流速度(TAP)、血流时间速度积分面积(VTI)、血管内径、每分血流量,并观察2组的疗效。结果治疗组总有效率为95.2%,对照组有效率为87.6%,2组比较差异无统计学意义(P>0.05)。血液流变学检查:治疗组术后1周的全血黏度低切、中切、高切,血浆粘度、红细胞压积、纤维蛋白原与术后1年比较差异均无统计学意义(均P>0.05);对照组术后1周的全血黏度低切、中切、高切,血浆粘度、红细胞压积、纤维蛋白原与术后1年比较差异均有统计学意义(P<0.05或P<0.01)。血流动力学检查:治疗组股总静脉、股浅静脉、股深静脉、腘静脉术后1周、1年血流动力学检查结果比较差异均无统计学意义(均P>0.05)。对照组股总静脉Vmin术后1周、1年,血流量术后1年、股浅静脉内径(nm)术后1年,股深静脉内径、血流量术后1年,腘静脉TAP、血流量术后1周、1年与参考值比较差异有统计学意义(P<0.05或P<0.01)。结论激光联合大隐静脉高位结扎术治疗原发性下肢静脉曲张手术方法安全、有效,疗效优于单纯激光治疗。

Objective To investigate the efficacy of laser treatment combined with high ligation of great saphenous vein in primary varicose veins of lower extremities.Methods A total of 291 patients with primary varicose veins of lower extremities were treated with laser alone（control group,145 cases） or in combination with high ligation of great saphenous vein（treatment group,146 cases）.Automatic hemorheology anayzer was used to measure whole blood viscosity at low shear rates（10 s-1）,middle shear rates（30 s-1） and high shear rates（100 s-1）,plasma viscosity（100 s-1）,hematocrit,and fibrinogen（g·L-1）.Color Doppler ultrasound was used to examine maximum systolic velocity（Vmax）,minimum diastolic velocity（Vmin）,average blood flow velocity（TAP）,flow time velocity integral（VTI） area,blood vessel diameter,and blood flow per minute（mL/min）.The therapeutic effects were observed.Results There were no significant differences in the total effective rate between the two groups（87.6% vs 95.2%,P0.05）.In treatment group,whole blood viscosity at low shear rates,middle shear rates and high shear rates,plasma viscosity,hematocrit,and fibrinogen measured after 1 week were not significantly different from those after 1 year（P0.05）,but in control group,these parameters after 1 week were obviously different from those after 1 year（P0.05 or P0.01）.Hemodynamics in femoral vein,superficial femoral vein,and deep femoral vein measured after 1 week were not statistically different from those after 1 year in treatment group（all P0.05）.In control group,femoral vein Vmin after 1 week and 1 year and blood flow after 1 year,superficial femoral vein diameter after 1 year,deep femoral vein diameter and blood flow after 1 year,and popliteal vein TAP and blood flow after 1 week and 1 year were significantly different from the reference values（P0.05 or P0.01）.Conclusion laser treatment combined with high ligation of great saphenous vein is safe and effective,and has greater efficacy than laser treatment alone for primary varicose veins of lower extremities.