透照下动力静脉切除术治疗下肢静脉曲张合并大隐静脉血栓形成的疗效观察

Effect of transilluminated powered phlebectomy on varicose veins of lower extremity with great saphenous venous thrombosis

目的探讨下肢静脉曲张合并大隐静脉血栓形成患者行透照下动力静脉切除术(transilluminated powered phlebectomy,TIPP)治疗的临床效果和安全性。方法下肢静脉曲张合并大隐静脉血栓形成患者56例,随机分为观察组和对照组各28例。对照组行大隐静脉高位结扎+主干顺行抽剥+分支点式剥脱术,观察组应用透光旋切系统(TriVexTM)行TIPP术。分别于术前及术后3、6个月行静脉临床严重程度评分(venous clinical severity score,VCSS)、下肢慢性静脉功能不全术后生活质量量表(chronic venous insufficiency questionnaire,CIVIQ)评分,比较2组切口数量、切口长度、手术时间、术中出血量、住院时间及术后并发症发生情况。结果术后3、6个月,VCSS评分在观察组[(4.02±0.77)、(1.29±0.46)分]、对照组[(4.54±0.51)、(2.04±0.74)分]均低于术前[(9.45±2.02)、(9.33±1.98)分],CIVIQ评分在观察组[(80.64±5.20)、(88.07±2.61)分]和对照组[(74.71±3.83)、(83.86±3.01)分]均高于术前[(54.36±12.35)、(55.25±13.58)分](P<0.05),且观察组术后3、6个月VCSS评分低于对照组,CIVIQ评分高于对照组(P<0.05);观察组切口数量[(2.36±0.49)个]、术中出血量[(45.71±8.25)mL]较对照组[(3.71±0.76)个、(61.25±7.53)mL]少(P<0.05),切口长度[(3.29±0.76)cm]、手术时间[(56.43±7.80)min]、住院时间[(7.04±1.14)d]较对照组[(5.00±0.94)cm、(79.29±6.49)min、(9.29±2.01)d]短(P<0.05);观察组术后皮下血肿发生率(21.4%)高于对照组(3.6%)(P<0.05),术后切口感染及皮肤感觉障碍发生率(7.1%、3.6%)低于对照组(21.4%、14.3%)(P<0.05),深静脉血栓形成、血栓性静脉炎发生率(0、3.6%)与对照组(3.6%、10.7%)比较差异无统计学意义(P>0.05)。结论 TIPP术治疗下肢静脉曲张合并大隐静脉血栓形成疗效满意,具有微创、手术及住院时间短、出血少、术后切口感染及皮肤感觉障碍发生率低的优点,但皮下血肿发生率高。

Objective To explore the effect and safety of transilluminated powered phlebectomy （TIPP） in the treatment of varicose vein of lower extremity with great saphenous venous thrombosis. Methods Fifty-six patients with varicose vein of lower extremity and great saphenous venous thrombosis were randomly divided into observation group and control group, with 28 patients in each group. Control group was performed high ligation of the great saphenous vein ± drainage of the main stem exfoliation at the branch point, and observation group was performed TIPP with the translucent rotary cutting system （TriVexTM ）. The venous clinical severity score （VCSS） and chronic venous insufficiency questionnaire （CIVIQ） score were evaluated in two groups before, and 3 and 6 months after operation respectively. The number of incision, the length of incision, the operation lasting time, the intraoperative blood loss, the hospitalization stay and the postoperative complications were compared between two groups. Results The postoperative 3- and 6-month VCSS scores were significantly lower in observation group （4. 02±0. 77, 1.29±0.46） and control group （4. 54±0.51, 2.04±0. 74） than those before operation （9. 45±2. 02, 9. 33± 1. 98）, CIVIQ scores were significantly higher in observation group （80. 64±5.20, 88.07±2. 61） and control group （74. 71±3.83, 83. 86±3. 01） than those before operation （54. 36±12. 35, 55. 25±13. 58） （P〈0.05）, while postoperative 3- and 6-month VCSS scores were significantly lower and CIVIQ scores were significantly higher in observation group than those in control group （P〈0.05）. The number of incision and intraoperative blood loss were significantly less, while the incision length, operation lasting time and hospitalization stay were significantly shorter in observation group （2.36 ± 0.49, （45.71 ± 8.25） mL, （3. 29±0. 76） cm, （56.43±7.80） min, （7.04±1. 14） d） than those in control group （3.71±0. 76, （61.25±7.53） mL, （5.00±0.94） cm, （79. 29±6. 49） min, （9.29±2.01） d） （P〈0.05）. The incidence of subcutaneous hematoma was significantly higher and the incidences of incision infection and paresthesia were significantly lower in observation group （21.4%, 7.1±, 3.6±） than those in control group （3.6%, 21.4%, 14.3%） （P〈0.05）, while there were no significant differences in the incidences of deep venous thrombosis and thrombophlebitis between observation group （0, 3.6%） and control group （3. 6%, 10. 7%） （P〈0.05）. Conclusion TIPP is effective for varicose veins of the lower extremities with great saphenous venous thrombosis, with the advantages of minimal invasion, short operation lasting time, short hospitalization stay, less intraoperative blood loss, and low incidences of postoperative incision infection and paresthesia, but the incidence of subcutaneous hematoma is high.