腔镜深筋膜下交通静脉离断联合小腿曲张静脉直视透光旋切术治疗活动性下肢静脉溃疡的早期疗效研究

Early stage effect comparison of lower limb venous ulcer(C6) treatment by combination of SEPS and Trivex system to SEPS

目的：比较单纯腔镜深筋膜下交通静脉离断术（SEPS）与SEPS联合小腿曲张静脉直视透光旋切术（Trivex术）治疗活动性下肢静脉溃疡的早期效果。方法选择2009年1月至2012年12月入院的下肢静脉溃疡患者156例，按住院号单、双将患者分为试验组（SEPS＋Trivex术）和对照组（SEPS术）。比较两组患者术后第1、3、6个月溃疡愈合、复发、下肢肿痛及局部皮肤麻木等并发症的发生率。结果术后1个月两组患者的溃疡愈合率差异无统计学意义，试验组术区肿痛及麻木感均显著高于对照组（26.3%vs 11.2%，23.8%vs 10.1%，P＜0.05），无患者溃疡复发；术后3个月试验组患者的溃疡愈合率高于对照组（80.0%vs 66.3%，P＜0.05），术区肿痛稍低于对照组（5.0%vs 5.6%），差异无统计学意义，麻木高于对照组（12.5%vs 3.4%，P＜0.05）；术后6个月试验组患者的溃疡愈合率高于对照组（91.3%vs 79.8%，P＜0.05），试验组及对照组术后6个月术区肿痛发生率分别为3.8%及2.4%，差异无统计学意义，术区麻木消失。术后第6个月试验组静脉溃疡复发率低于对照组（1.25%vs 7.87%，P＜0.05）。两组患者术中及随访期间均未出现死亡病例，未发生深静脉血栓形成等严重并发症。结论虽然SEPS＋Trivex术后短期（1~3个月）轻微并发症的发生率较高，但在术后早期（6个月内）静脉溃疡治愈率更高，复发率更低，因此更适合下肢静脉溃疡的治疗。

Objective To compare the early stage treatment effect of lower limb venous ulcer （C6） by subfascial endoscopic perforator surgery （SEPS） to SEPS and Trivex system. Methods According to singular or even hospital number, one hundred and fifty-six patients of venous ulcer in lower limb adopted from January 2009 to December 2012 were divided into two groups. Experimental group：singular hospital number, treated by combination of SEPS and Trivex system, saphenous vein ligation and stripping, percutaneous and continuous venule circumsuture at the same time;control group：even hospital number, treated by SEPS, and saphenous vein ligation and stripping, percutaneous and continuous venule circumsuture. Results In the first month, the healing rate in two groups had no statistically significant differences;pain and numbness in experimental group was much higher than control group （26.3%vs 11.2%, 23.8%vs 10.1%, P〈 0.05）. There was no ulcer recurrence in the two groups. In the third month, the healing rate in experimental group was much higher than control group （80.0%vs 66.3%, P〈0.05） , and numbness in experimental group was much higher than control group （12.5%vs 3.4%, P〈0.05）. In the sixth month, the healing rate in experimental group was higher than control group （91.3%vs 79.8%, P 〈0.05） . No patient felt pain and numbness. The recurrent rate of ulcer in experimental group was lower than control group （1.25%vs 7.87%, P〈 0.05）. All patients in the two groups had no serious complications, but subcutaneous hematoma and skin numbness after operation was much higher than control group in the first month （P〈0.05）, and became the same in the sixth month. Conculsion Though the slight complications of experimental group such as subcutaneous hematoma and skin numbness after operation are much higher than SEPS group in the first to third month, combination of Trivex system with SEPS is a better way to treat venous ulcerv （C6） in lower limb for a higher healing rate and a lower recurrence rate.