Mullers手术治疗129例下肢静脉曲张伴血栓性浅表静脉炎患者的临床研究

Mullers phlebectomy in the treatment of 129 cases of lower limb varicose veins with superficial thrombophlebitis

目的探讨Mullers手术治疗下肢静脉曲张伴血栓性浅表静脉炎的疗效。方法收集2014年10月至2016年10月129例下肢静脉曲张伴血栓性浅表静脉炎患者(静脉炎组)和137例下肢静脉曲张患者(静脉曲张组)的临床资料。两组均采用Mullers手术治疗,围手术期给予改善微循环治疗,术后6小时开始口服利伐沙班,每日10 mg,持续2天。ELISA法检测两组术前、术后2天外周血IL-1β表达水平的变化。结果两组症状均不同程度缓解,有效率100%,静脉炎组与静脉曲张组相比较,两组手术时间、术中出血量、切口数(直径≥5 mm)、术中出血量、术后淋巴水肿、隐神经损伤率、深静脉血栓发生率、切口感染、住院总费用,差异无统计学意义(P>0.05);皮下硬结、皮下瘀斑的个数静脉炎组较静脉曲张组高,差异有统计学意义(P<0.01)。ELISA法检测静脉炎组术前IL-1β浓度明显高于静脉曲张组(P<0.01),静脉炎组术后IL-1β浓度较术前下降,差异有统计学意义(P<0.01)。结论下肢静脉曲张伴血栓性浅表静脉炎采用Mullers手术治疗安全、有效,是治疗下肢血栓性浅表静脉炎的主要临床治疗方法,术后有必要抗凝治疗。

Objective To compare the clinical results of Mullers phlebectomy treatment in varicose veins versus thrombophlebitis varicose veins of lower extremity. Methods 137 cases of varicose veins of lower extremity without thrombophlebitis（varicose veins group） and 129 cases of varicose veins thrombophlebitis of lower extremity（phlebitis group） were treated with Mullers surgery. Both groups were administrated with microcirculation improving agents before surgery and rivaroxaban anticoagulation from pre-operative 6 hours to 2 days after surgery. ELLSA assay was performed to detect the expression of IL-1βin two groups before and after 2 days after surgery. Results The symptoms were relieved with different degrees in both groups, the efficiency was 100%. There were no statistical differences on operation time,blood loss, incision number（diameter larger than 5 mm）, postoperative lymphedema, saphenous nerve injury rate, incidence of deep venous thrombosis, surgical site infection and total cost of hospitalization between two groups（P0.05）. The number of subcutaneous tissue induration and ecchymosis in phlebitis group was more than that in varicose veins group（P〈0.01）. The patient satisfaction rate was significantly higher in the observation treatment group than the control group（P0.05）. The IL-1β level were significantly higher in the phlebitis group than varicose veins group before surgery or 2 days after surgery（P〈0.01）. In the phlebitis group, the IL-1β level significantly decreased after surgery（P〈0.01）. Conclusion Mullers surgery is safe and effective. It is the main clinical treatment option for varicose veins thrombophlebitis of lower extremity.Anticoagulation agent should be administrated after the surgery.