彩色多普勒超声结合“筋瘤”分型治疗在大隐静脉曲张患者个体化治疗中的价值

The Value of Color Doppler Ultrasound and Phased Therapy of“Tumorous Varix”in the Individualized Therapy for GSVV Patients

目的:探讨彩色多普勒超声结合“筋瘤”分型治疗在大隐静脉曲张(great saphenous vein varicosis,GSVV)患者个体化治疗中的价值。方法:分析2014年1月至2018年6月医院采用射频腔内消融联合个体化点式剥脱治疗下肢大隐静脉曲张伴溃疡患者212例(共261条患肢)的临床资料,资料显示患者被随机分为中医治疗组、常规手术组各106例,常规手术组实施手术治疗,中医治疗组根据辨证分型分别给予补中益气汤、暖肝煎合当归四逆汤及活血散瘀汤加减治疗,服药7天后行手术治疗;所有患者术前均进行彩色多普勒超声检查并定位,标记小腿段功能不全的交通静脉,术中实时监测、定点,术后进行彩色多普勒超声评估。结果:中医治疗组、常规手术组患者术后24 h VAS评分分别为(2.07±0.46)分、(2.51±0.69)分,溃疡愈合时间分别为(9.51±0.23)天、(10.91±0.27)天,两组比较差异均有统计学意义(P<0.05);恢复正常活动时间分别为(3.09±0.33)天、(3.21±0.29)天,首次下地时间分别为(9.27±0.23)h、(9.18±0.21)h,两组比较差异均无统计学意义(P>0.05);术后切口感染率、复发率、出血中医治疗组分别为6.1%、2.3%、0.8%,常规手术组分别为7.7%、2.3%、1.5%,两组比较差异均无统计学意义(P>0.05);两组患者均无下肢深静脉血栓、肺栓塞、皮肤灼伤等并发症发生。术后随访12~18个月,溃疡均愈合。结论:彩色多普勒超声结合“筋瘤”分型治疗可有效缩短大隐静脉曲张患者溃疡愈合时间,减少创伤,具有安全、有效、并发症少、术后疼痛轻的优点。

Objective:To explore the values of color Doppler ultrasound and phased therapy of"tumorous varix"in the individualized therapy for the patients suffering great saphenous vein varicosis(GSVV).Methods:Clinical data of 212 patients who were suffering GSVV and ulcer(all 216 affected limbs),and treated by radiofrequency ablation combined with individualized punctuate stripping from January,2014 to June,2018 in our hospital were retrospectively analyzed,and the data showed that the patients were randomized into TCM therapy group and conventional surgery group,106 cases each group,the conventional therapy group accepted the surgery,TCM therapy group were given Buzhong Yiqi Tang,Nuangan Jian and Danggui Sini Tang,and modified Huoxue Sanyu Tang respectively according to syndrome differentiation and typing,they accepted the surgery after they were medicated for seven days;all the patients performed color Doppler ultrasound before surgery to fix position and sign the dysfunctional veins of the lower leg,real-time monitoring and fix the position in the surgery,and color Doppler ultrasound evaluation after the surgery.Results:VAS scores of TCM therapy group and conventional surgery group were(2.07±0.46)points and(2.51±0.69)points 24 hours after the surgery,ulcer healing time were(9.51±0.23)days and(10.91±0.27)days respectively,and the difference had statistical meaning between both groups(P<0.05);the time of restoring normal activity were(3.09±0.33)days and(3.21±0.29)days respectively,initial off-bed time were(9.27±0.23)h and(9.18±0.21)h respectively,and the difference showed no statistical meaning between both groups(P>0.05);postoperative incision infection rate,relapse rate and bleeding rate of TCM therapy group were 6.1%,2.3%and 0.8%respectively,these of conventional surgery group were 7.7%,2.3%and 1.5%respectively,and the difference had no statistical meaning(P>0.05);No complications happened such as deep vein thrombosis of lower extremities,pulmonary embolism,skin burn and others in both groups.The ulcer healed in the follow-ups of 12 to 18 months after the surgery.Conclusion:Color Doppler ultrasound and phased therapy of"tumorous varix"could effectively shorten ulcer healing time and reduce the trauma,it possesses the advantages of being safe,effective,fewer complications and postoperative pain alleviation.