泡沫硬化剂与腔内激光治疗小腿部静脉曲张术后并发症的比较分析

Postoperative complications of patients with varicose vein of lower limbs treated with foam sclerotherapy and endovenous laser

目的比较分析泡沫硬化剂与腔内激光治疗小腿部静脉曲张的术后并发症情况。方法2011年1月-2015年12月本中心收治单纯大隐静脉曲张患者（C3-6级）2542例。3468条肢体，按治疗方法不同分两组。两组均行大隐静脉高位结扎＋大腿段主干剥脱术，泡沫硬化剂组（1355例）行小腿部泡沫硬化剂治疗（1％聚多卡醇），腔内激光组（1187例）行小腿部腔内激光灼闭术。术后均予弹力袜治疗3个月。术后3d、1周、1个月、3个月、6个月进行随访。比较两组（组间及组内）术后疼痛（小腿部）、深静脉血栓形成、肺栓塞、血栓性浅静脉炎、隐神经损伤、皮下瘀血、偏头痛、皮肤灼伤、色素沉着、术后残留等并发症。结果两组病例均顺利完成手术。泡沫硬化剂组出现隐神经损伤28例（2．0％），皮下瘀血1071例（79．1％），皮肤灼伤0例（0．0％），腔内激光组分别为613例（51．6％）、979例（82．5％）、8例（1．0％），差异有统计学意义（χ^2分别为824．660。4．786，9．161，P〈0．05）；皮肤色素沉着腔内激光组（23．8％）明显优于泡沫硬化剂组（30．8％）（r=15．243，P〈0．05）。结论泡沫硬化剂治疗小腿部静脉曲张较腔内激光术后并发症更少、更轻。

Objective To Compare postoperative complications between patients with varicose veins of the lower limbs treated with foam sclerotherapy or endovenous laser. Method From 2011 to 2015, simple varicosis of great saphenous vein patients （ grade C3-6） in 2 542 cases, 3 468 limbs were divided into 2 groups. Combined with high ligation of great saphenous vein plus stripping, foam sclerotherapy group （ 1 355 cases） underwent calf foam sclerotherapy （ 1% polidocanol） , endovenous laser group （ 1 187 cases） underwent endovenous laser therapy. All postoperative patients were treated with stretch socks for 3 months. Postoperative pain （calf）, deep vein thrombosis, pulmonary embolism, superficial thrombophlebitis, saphenous nerve injury, ecchymoma, migraine, allergic dermatitis, pigmentation in 2 groups were compared. Result During the follow-up, 28 cases in foam sclerotherapy group had saphenous nerve injury （2%） , 1 071 （79. 1% ） cases had subcutaneous ecchymosis, 613 cases （51.6%） in endovenous laser group had saphenous nerve injury, 979 cases （82. 5% ） had subcutaneous ecchymosis, 8 cases （ 1.0% ） had skin bums （χ^2= 824. 660, 4. 786, 9. 161, P 〈 0. 05 ） . Endovenous laser group （ 23.8% ） was significantly better than that of foam sclerotherapy group （ 30. 8% ） in pigmentation （χ^2=15. 243, P 〈 0. 05）. Conclusion Treatment of varicose veins of the lower leg with foam sclerotherapy has less postoperative complications compared with endovenous laser.