高位结扎联合点式与传统剥脱术应用于大隐静脉曲张患者的临床对比

Clinical comparison of high ligation combined with dot and traditional stripping in patients with varicose great saphenous vein

目的 探讨高位结扎联合点式与传统剥脱术应用于大隐静脉曲张患者的临床效果。方法 80例研究对象均选自北京市通州区西集卫生院2018年9月至2021年7月收治的大隐静脉曲张患者,随机数字表法将其分为对照组和观察组,每组各40例。对照组患者予以大隐静脉高位结扎联合传统剥脱术治疗,观察组患者予以大隐静脉高位结扎联合点式剥脱术治疗,两组患者均跟踪至出院。比较两组患者的住院时间、手术时间、下床活动时间、术中失血量等术中、术后情况,术前及术后3d的血清肿瘤坏死因子-α、白介素-6、一氧化氮水平,以及术前及术后7d的视觉模拟评分法(visual analogue scale,VAS)、静脉临床严重程度评分表(venous clinical severity score,VCSS)、生活质量调查表(chronic venous insufficiency questionnaire,CIVIQ)评分情况。结果 观察组患者的住院时间及手术时间均短于对照组,下床活动时间早于对照组,术中出血量少于对照组(P均<0.05)。与术前比,两组患者术后3d的血清肿瘤坏死因子-α、白介素-6、一氧化氮水平均升高,但观察组患者升高幅度较对照组低(P <0.05)。与术前比,两组患者术后7d的VAS、VCSS评分均降低、CIVIQ评分升高,且观察组患者的VAS、VCSS评分降低幅度优于对照组(P <0.05),CIVIQ评分升高幅度优于对照组(P <0.05)。结论 与传统剥脱术相比,高位结扎联合点式剥脱术可以有效缩短大隐静脉曲张患者的术后下床活动时间、手术及住院时间,减少术中失血量,减轻患者的疼痛感与应激反应,提高患者的生活质量。

Objective To investigate the clinical effect of high ligation combined with dot and traditional stripping in patients with varicose great saphenous vein. Method 80 subjects were selected from patients with great saphenous varices treated in Xiji Health Center of Tongzhou District in Beijing from September 2018 to July 2021. They were randomly divided into control group and observation group, with 40 cases in each group. The patients in the control group were treated with high ligation of great saphenous vein combined with traditional stripping, and the patients in the observation group were treated with high ligation of great saphenous vein combined with dot stripping. The patients in both groups were followed up to discharge. The hospital stay, operation time, out of bed activity time,intraoperative blood loss and the levels of serum tumor necrosis factor-a, interleukin-6 and nitric oxide before and 3 days after operation were compared between the two groups, the Visual analogue scale(VAS), venous clinical severity score(VCSS), and chronic venous insufficiency questionnaire(CIVIQ)were also compared between the two groups. Result The hospitalization time and operation time of the observation group were shorter than those of the control group, the activity time of getting out of bed was earlier than that of the control group, and the amount of intraoperative bleeding was less than that of the control group(all P < 0.05). Compared with before operation, the levels of serum tumor necrosis factor-a, interleukin-6 and nitric oxide in the two groups increased three days after operation,but the increase range of patients in the observation group was lower than that in the control group(P < 0.05). Compared with before operation, the VAS and VCSS scores of the two groups decreased and CIVIQ scores increased 7 days after operation, and the decrease range of VAS and VCSS scores in the observation group was better than that in the control group(P < 0.05), CIVIQ score increased significantly better than the control group(P < 0.05). Conclusion Compared with traditional stripping,high ligation combined with dot stripping can effectively shorten the time of getting out of bed, operation and hospitalization, reduce intraoperative blood loss, reduce pain and stress reaction, and improve the quality of life of patients with great saphenous vein varicose.