腔镜筋膜下交通支离断术在下肢复杂性溃疡中的应用

Application of subfascial endoscopic perforator surgery in mixed etiology leg ulcer

目的:对比腔镜筋膜下交通支离断术与交通静脉腔内激光闭合术治疗下肢动静脉复杂性溃疡的效果。方法:将2014年1月至2018年1月收治的131例动静脉复杂性溃疡患者随机分为治疗组(67例,83条肢体)与对照组(64例,89条肢体),治疗组采用腔镜筋膜下交通支离断术联合压迫疗法,对照组采用交通静脉腔内激光闭合术联合压迫疗法,对比两组治疗效果。结果:对照组手术时间[(26.05±5.76)min vs.(35.55±6.17)min]、术中出血量[3.52(2.02~4.26)mL vs.6.47(5.30~8.24)mL]优于治疗组(P<0.05);治疗组溃疡面积[(6.33±2.10)cm 2 vs.(10.41±4.02)cm 2]、静脉临床严重程度评分[7(5~9)vs.8(6~10)]、术后生活质量评分[(113.27±7.29)vs.(108.66±11.47)]优于对照组(P<0.05)。结论:腔镜筋膜下交通支离断术与交通静脉腔内激光闭合术联合压迫疗法是治疗动静脉复杂性溃疡的合理方案,腔镜筋膜下交通支离断术联合压迫疗法疗效更为显著。

Objective:To investigate the effects of subfascial endoscopic perforator surgery(SEPS)and endovenous perforator laser treatment(EVPLT)in the treatment of mixed etiology leg ulcer(MELU).Methods:One hundred and thirty-one patients with MELU treated during Jan.2014 and Jan.2018 were separated into treating group(67 patients,83 limbs)and control group(64 patients,89 limbs)randomly.The patients in treating group received SEPS combined compression therapy while patients in control group received EVPLT combined compression therapy.The therapeutic effect of 2 groups were compared.Results:EVPLT had obvious superiority in reducing operation time[(26.05±5.76)min vs.(35.55±6.17)min,P<0.05]and bleeding[3.52(2.02-4.26)mL vs.6.47(5.30-8.24)mL,P<0.05],SEPS had remarkable effect in ulcer healing[(6.33±2.10)cm 2 vs.(10.41±4.02)cm 2],reducing venous clinical severity score[7(5-9)vs.8(6-10)]and enhancing patient’s daily life quality[(113.27±7.29)vs.(108.66±11.47)](P<0.05).Conclusions:SEPS and EVPLT combined compression therapy are reasonable plans in treating MELU,SEPS combined compression therapy is more effective.