腔镜深筋膜下交通支离断联合腔内激光灼闭术治疗下肢静脉性溃疡的疗效观察

Effect of Endoscopic Subfascial Branch Dissection Combined with Intracavitary Laser Cauterization in the Treatment of Venous Ulcer of Lower Extremity

目的探讨腔镜在深筋膜下交通支离断术联合曲张静脉激光灼闭术治疗C6级下肢静脉溃疡的早、中期疗效。方法选择2013年1月～2017年12月入住广西柳州市工人医院的活动性下肢静脉性溃疡患者150例,将住院号按随机数字表法分为三组,每组50例。试验组行SEPS+EVLT治疗,对照A组行SEPS治疗,对照B组行EVLT治疗。比较三组患者术后肢体皮肤溃疡愈合率、愈合时间、术后疼痛感、麻木感、皮肤瘀斑不良反应的发生率,以及溃疡复发率。术后随访时间3～36个月。结果试验组患者溃疡愈合率在术后1个月高于对照A组和B组(62.60%vs 59.30%vs 57.50%),差异无统计学意义(P>0.05);术后3个月、6个月均高于对照A组和B组(3个月:90.50%vs 52.40%vs 49.70%;6个月:100.00%vs 68.20%vs 59.30%),差异有统计学意义(P>0.05);术后对照组A和B组的溃疡愈合率在术后各个时期比较,差异无统计学意义(P>0.05)。溃疡愈合时间为试验组平均(27.20±3.10)d,对照A组平均(42.40±5.30) d,对照B组平均(50.30±4.10)d,试验组短于对照组A、B组,差异有统计学意义(P<0.05)。三组患者术后不良反应发生率(4.20%vs 3.20%vs 3.50%)对比,差异无统计学意义(P>0.05)。术后第24个月试验组皮肤溃疡复发率低于对照A组和B组(1.12%vs6.89%vs8.06%),差异有统计学意义(P<0.05)。三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。结论腔镜深筋膜下交通支离断联合静脉激光灼闭治疗下肢静脉性溃疡早期疗效显著、安全可靠,且能够较好地预防溃疡中期复发,值得临床应用,但仍需要大规模随机临床研究来进一步证实其远期疗效。

Objective To investigate the early and intermediate efficacy of endoscopic resection of subfascial communicating branchcombined with varicose vein laser cauterization in the treatment of C6 grade lower extremity venous ulcer.Methods 150 patients withactive venous ulcer of lower extremity were selected from January 2013 to December 2017 in Guangxi Liuzhou Workers Hospital.Thehospital numbers were randomly divided into three groups,50 cases in each group.The experimental group received SEPS ＋EVLTtreatment,while the control group A received SEPS treatment,while the control group B received EVLT treatment.The healing rate,healing time,postoperative pain,numbness,skin ecchymosis and recurrence rate of skin ulcer were compared among the three groups.The follow-up time was 3~36 months.Results The ulcer healing rate of the experimental group was higher than that of the controlgroup A and B（62.60%vs59.30%vs57.50%）at 1 month after operation,the difference was not statistically significant（ P〉0.05）;3 monthsafter surgery,6 months were higher than the control group A and B （3 months：90.50%vs52.40%vs49.70%;6 months：100.00%vs68.20%vs 59.30%）,the difference was statistically significant（ PP〉0.05）;The ulcer healing rate of the control group A and B in the postoperativeperiod was not statistically significant（ PP〉0.05）.The healing time of ulcer was the average of the experimental group（27.20±3.10）d,theaverage of the control group （42.40±5.30）d,the average of the control group B （50.30±4.10）d,and the experimental group was shorterthan the control group A and B,the difference was statistically significant（ P〈0.05）.The incidence of postoperative adverse reactions inthe three groups was 4.20%vs3.20%vs3.50%,the difference was not statistically significant（ PP〉0.05）.The recurrence rate of skin ulcerin the experimental group was lower than that in the control group A and group B （1.12%vs6.89%vs8.06%）at the 24th month afteroperation,the difference was statistically significant（ P〈0.05）.There were no deaths in the three groups during and during the follow-upperiod, and no serious complications such as deep vein thrombosis occurred.Conclusion Endoscopic subfascial branch dissectioncombined with laser cauterization of vein in the treatment of lower extremity venous ulcers is effective,safe and reliable,and canprevent the recurrence of ulcers in the middle stage,which is worthy of clinical application.However,large-scale randomized clinicalstudies are still needed to further confirm its long-term efficacy.