腔内激光联合泡沫硬化的两种术式对下肢静脉曲张的疗效比较

Efficacy Comparison of Two Surgical Methods of Endovenous Laser Treatment Combined with Foam Sclerotherapy for Varicose Veins of the Lower Limbs

目的:比较静脉腔内激光治疗(EVLT)联合泡沫硬化的两种术式对下肢静脉曲张的疗效分析。方法:选取武汉大学中南医院2015年4月至2016年4月下肢静脉曲张患者120例,均先行大隐静脉高位结扎,其中60例(A组)行EVLT(主干)+泡沫硬化剂(属支及曲张静脉团),60例(B组)选择EVLT(主干、属支及大的曲张静脉团)+泡沫硬化剂(残留曲张静脉)。比较两组患者围手术期情况、术后并发症发生率和复发率,并对术前、术后半年静脉临床严重程度评分(VCSS)等指标进行评分。结果:B组较A组手术时间长,住院费用高,术后并发症(疼痛、皮下灼伤、皮下瘀血、肢体麻木)发生率高,差异有统计学意义(P<0.05);术中出血量、术后下床活动时间、住院时间、血栓性浅静脉炎发生率及术后复发率比较,差异无统计学意义(P>0.05);两组术后半年VCSS评分与术前比较均明显下降,差异有统计学意义(P<0.05),但组间比较无统计学差异(P>0.05)。结论:大隐静脉高位结扎加EVLT(主干)联合泡沫硬化剂(属支及曲张静脉团)的治疗方式具有手术时间短,并发症少,疗效好、经济实惠等优势,更值得临床推广应用。

Objective：To compare the effectiveness of two treatments of endovenous laser treatment（EVLT）combined with foam sclerotherapy for varicose veins of the lower limbs.Methods：From April 2015 to April 2016,120 patients with varicose veins in our hospital were randomly divided into two groups.Firstly,all patients were given high saphenous vein ligation.Then,60patients（Group A）were treated with EVLT（trunk）plus foam sclerotherapy（branch and varicose vein group）,while another 60patients（Group B）were treated with EVLT（trunk,branch and large varicose veins）plus foam sclerotherapy（residual varicose veins）.The status of perioperative period,the postoperative complication rate and the recurrence rate were compared between the two groups.The venous clinical severity score was also evaluated before operation and after half-oneyear operation.Results：The operative time,cost of hospitalization incidence of pain,skin burn,skin bleeding and limb numbness were higher in group B than those in group A after operation（P〈0.05）.No statistically significant difference in perioperative bleeding,postoperative time of out of bed,hospital stay,incidence of thrombophlebitis superficial phlebitis and postopertive recurrence rate between the two groups（P〈0.05）.Six months after the operation the venous clinical severity score decreased in both groups（P〈0.05）,and there were no significant differences between them（P〈0.05）.Conclusion：High saphenous vein ligation plus EVLT（trunk）with foam sclerotherapy（branch and varicose vein group）is worth clinical application for lower extremity varicosity due to its advantages of shorter operative time,fewer complications,better effects,and affordability.