手术治疗与腔内联合手术治疗对左侧髂静脉压迫综合征合并下肢静脉曲张的疗效对比

Comparison of the effect of surgical treatment alone and combined endovascular and surgical treatment on left iliac vein compression syndrome with varicose veins of lower extremities

目的探讨单纯手术治疗与腔内联合手术治疗对左侧髂静脉压迫综合征(IVCS)合并下肢静脉曲张的短期疗效。方法收集2016年1月至2018年1月成都中医药大学附属医院收治的60例IVCS合并下肢静脉曲张患者的临床资料,并按照治疗方式不同将患者分为两组,将在不治疗左侧IVCS的情况下采取单纯手术治疗下肢静脉曲张的患者作为单纯手术组,将同期对左侧IVCS行腔内治疗(左髂静脉球囊扩张支架植入术)后行左下肢静脉曲张手术的患者作为联合治疗组,每组30例。比较两组患者的手术成功率、围手术期情况;通过静脉临床严重程度评分(VCSS)、慢性静脉疾病生活质量问卷(CIVIQ)评分比较两组患者的临床疗效;比较两组患者的并发症发生情况。结果两组患者的手术成功率均为100%,均未发生下肢深静脉血栓形成。两组患者的皮肤感觉异常、皮肤瘀斑、皮下血肿情况比较,差异均无统计学意义(P>0.05)。随访期间,支架通畅率为100%。联合治疗组患者出院后12个月的VCSS评分低于单纯手术组患者,CIVIQ评分高于单纯手术组患者,差异均有统计学意义(P<0.05)。联合治疗组患者未出现髂静脉支架闭塞及明显复发的静脉曲张。结论左侧IVCS合并下肢静脉曲张患者行单纯手术治疗或腔内联合手术治疗均是安全、有效的,其中,行腔内联合手术治疗的患者短期内生活质量改善效果更佳。

Objective To investigate the short-term effect of surgical treatment alone and combined intracavitary surgical treatment on left iliac vein compression syndrome(IVCS)with varicose veins of the lower extremities.Method The clinical data of 60 patients with left IVCS with varicose veins of the lower extremities admitted to Hospital of Chengdu University of Traditional Chinese Medicine from January 2016 to January 2018 were collected.According to different treatment methods,the patients were divided into two groups.Patients who underwent surgery for varicose veins of the lower extremities without treatment of left IVCS were recognized as the surgery alone group and patients who underwent varicose veins of the left lower extremities during the same period after the endovascular and surgical treatment of the left IVCS(left iliac vein balloon dilatation stent implantation)were regarded as the combined treatment group,with 30 cases in each group.The surgical success rate and perioperative conditions of the two groups of patients were compared;the clinical efficacy of the two groups was compared based on the venous clinical severity score(VCSS)and the chronic venous insufficiency quality of life questionnaire(CIVIQ)score;the complications of the two groups were also compared.Result The surgical success rate of the two groups of patients was 100%,and there were no lower extremities deep venous thrombosis reported.There was no statistically significant difference in skin paresthesia,skin ecchymosis,and subcutaneous hematoma between the two groups of patients(P>0.05).During the follow-up,the patency rate of the stent was 100%.The VCSS score of the patients in the combined treatment group was lower than that of the patients in the surgery alone group 12 months after the surgery,and the CIVIQ score was higher than that of the patients in the surgery alone group,and the differences were statistically significant(P<0.05).Patients in the combined treatment group did not suffer iliac vein stent occlusion and obvious recurrence of varicose veins.Conclusion Left IVCS combined with lower extremity vein surgery alone or combined endovascular and surgical treatment are safe and effective.Of which,patients undergoing combined endovascular and surgical treatment have achieved better results in the improvement of the life quality in the short term.