两种手术方式治疗下肢静脉曲张伴病理性穿通静脉功能不全的疗效分析

Efficacy of two surgical methods in lower extremity varicose vein complicated with pathologically incompetent perforating vein

目的探讨两种手术方式治疗下肢静脉曲张伴病理性穿通静脉功能不全的疗效。方法收集2013年8月至2020年7月德州市人民医院住院行手术治疗的331例(394条患肢)下肢静脉曲张患者的临床资料,根据不同的处理方式分为穿通静脉腔内激光闭合术(EVLA)组(232例,280条患肢)和内镜筋膜下穿通静脉离断术(SEPS)组(99例,114条患肢)。比较两组患者的手术时间、术中出血量、术后第1天疼痛程度、隐神经损伤发生率、术后住院天数、术后切口愈合不良发生率、术后1年随访症状复发率及穿通静脉复通率。结果EVLA组手术时间短于SEPS组,差异有统计学意义(P<0.05)。术后第1天EVLA组疼痛评分低于SEPS组,差异有统计学意义(P<0.05)。EVLA组术中出血量少于SEPS组,差异有统计学意义(P<0.05)。两组患者的切口愈合不良发生率、隐神经损伤发生率、术后住院天数、术后1年穿通静脉复通率、症状复发率比较,差异均无统计学意义(P>0.05)。结论两种手术方式均是治疗下肢静脉曲张伴病理性穿通静脉功能不全的有效手段,然而两者也有自身的优缺点,广大医务工作者应根据患者的具体情况酌情选用。

Objective To explore the efficacy of two surgical methods in lower extremity varicose vein complicated with pathologically incompetent perforating vein.Method A total of 394 lower extremities of 331 patients with varicose vein of lower extremity who were treated in Dezhou People’s Hospital from August 2013 to July 2020 were selected.According to the different treatment methods,232 patients with 280 lower extremities were divided into in the endovenous laser ablation(EVLA)group and 99 patients with 114 lower extremities in the subfascial endoscopic perforator surgery(SEPS)group.The operative time,intraoperative blood loss,postoperative pain on the first day,incidence of saphenous nerve injury,postoperative length of hospital stay,incidence of postoperative poor incision healing,recurrence rate of symptoms in 1 year after surgery and the rate of venous recanalization of two groups were analyzed.Result The operation time of EVLA group was shorter than that of SEPS group(P<0.05).The pain score of EVLA group was lower than that of SEPS group on postoperative day 1(P<0.05).The intraoperative blood loss in EVLA group was less than that in SEPS group(P<0.05).There were no statistically significant differences in the incidence of poor incision healing,saphenous nerve injury,postoperative hospital stay,1 year postoperative venous recanalization rate and symptom recurrence rate between the two groups(P>0.05).Conclusion Both methods are effective methods in treating perforating vein regurgitation,and both with advantages and disadvantages.Medical professionals need to make decision based on clinical practice.