EVLT联合大隐静脉高位结扎术治疗下肢静脉曲张临床效果观察

Clinical observation of EVLT combined with high ligation of great saphenous vein in the treatment of varicose veins of lower limbs

目的观察腔内激光治疗(endovenous laser treatment,EVLT)联合大隐静脉高位结扎术治疗下肢静脉曲张的临床效果。方法将90例(116肢)下肢静脉曲张患者根据治疗方法分为观察组(采用EVLT联合大隐静脉高位结扎术治疗,48例,61肢)和对照组(采用大隐静脉高位结扎剥脱术治疗,42例,55肢)。比较2组手术一般情况、术后隐神经损伤发生率、并发症发生率、溃疡愈合率、色素沉着减退率及曲张复发率,并采用慢性静脉功能不全问卷(chronic venous insufficiency questionnaire,CIVIQ)评价术后生活质量。结果观察组手术时间、术中出血量、切口长度及住院时间均短于或少于对照组( P < 0.05);2组溃疡愈合率、色素沉着减退率及曲张复发率差异均无统计学意义( P > 0.05);观察组术后切口愈合不良、皮下血肿及患肢疼痛发生率均明显低于对照组( P < 0.05);2组术后发热、踝和足背部水肿以及隐神经损伤发生率差异均无统计学意义( P > 0.05);观察组术后CIVIQ评分中的疼痛、社会活动、体能、精神心理和总分均高于对照组( P < 0.05)。结论 EVLT联合大隐静脉高位结扎术治疗下肢静脉曲张手术时间短、术中出血量少、术后并发症少,且术后CIVIO评分高于大隐静脉高位结扎剥脱术,值得临床推广。

Objective To observe the clinical curative effect of endovenous laser treatment(EVLT) combined with high ligation of great saphenous vein in the treatment of varicose veins of lower limbs. Methods Ninety patients(116 limbs)with varicose veins of lower limbs were divided into observation group(given EVLT combined with high ligation of great saphenous vein, 48 cases, 61 limbs) and control group(high ligation of great saphenous vein and stripping, 42 cases, 55 limbs) according to the treatment methods. The general condition of operation, incidence of postoperative saphenous nerve injury, incidence of complications, healing rate of ulcer, reduction rate of hyperpigmentation and recurrence rate of varix were compared between the two groups. The chronic venous insufficiency questionnaire(CIVIQ) was performed to evaluate the postoperative quality of life. Results The operative time, intraoperative blood loss, incision length and hospital stay in observation group were significantly shorter or less than those in control group( P < 0.05). There were no significantly differences in healing rate of ulcer, reduction rate of hyperpigmentation and recurrence rate of varix between two groups( P > 0.05). The incidence rates of postoperative poor incision healing, subcutaneous hematoma and pain of affected limb in observation group were significantly lower than those in control group( P < 0.05). There were no significant differences in the incidence rates of postoperative fever, edema of ankle and foot dorsum and saphenous nerve injury between two groups( P > 0.05). The scores of pain, social activities, physical fitness and mental psychology and total score of CIVIQ in observation group were higher than those in control group( P < 0.05). Conclusion EVLT combined with high ligation of great saphenous vein has short operative time, little intraoperative blood loss and few postoperative complications in the treatment of varicose veins of lower limbs, and its CIVIO scores are higher than those of high ligation of saphenous vein and stripping, thus it is worthy of clinical promotion.