大隐静脉高位结扎术联合点式剥脱术对大隐静脉曲张患者的临床疗效

Clinical effect of high ligation of great saphenous vein combined punctate stripping for great saphenous vein varicose

目的探讨大隐静脉高位结扎术联合点式剥脱术对大隐静脉曲张患者的临床疗效。方法收集2019年1月至2020年1月于湖北省第三人民医院进行手术治疗的78例大隐静脉曲张患者的临床资料,根据手术方式的不同将患者分为传统组(采取大隐静脉高位结扎术联合传统剥脱术治疗)和点式组(采取大隐静脉高位结扎术联合点式剥脱术治疗),每组39例。比较两组患者的手术指标(手术时间、下床时间、住院时间和术中出血量)、术后4周的临床疗效、术前与术后3 d的应激反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)]、凝血功能指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]。观察并比较两组患者术后不良反应发生情况及术后1年复发率。结果点式组患者的手术时间、下床时间、住院时间均明显短于传统组患者,术中出血量明显少于传统组患者(P<0.01)。术后4周,点式组患者的临床总有效率高于传统组患者,临床疗效明显优于传统组患者(P<0.01)。术后3 d,点式组患者的IL-6、TNF-α、NO、FIB、D-D水平均低于传统组患者,APTT、PT、TT均长于传统组患者(P<0.05)。点式组患者的术后并发症总发生率、术后1年复发率均低于传统组患者(P<0.05)。结论大隐静脉高位结扎术联合点式剥脱术能够提高对大隐静脉曲张患者的临床疗效,减轻术后炎性反应和血液高凝反应,改善血管内皮功能,降低复发率。

Objective To investigate the effect of high ligation of great saphenous vein combined punctate stripping for great saphenous vein varicose.Method Clinical data of 78 patients with great saphenous varicose vein(GSV)who were treated by surgery in Hubei Third People's Hospital from January 2019 to January 2020 were collected.The patients were divided into traditional group(n=39,treated with high ligation+traditional stripping)and punctate group(n=39,treated with high ligation+punctate stripping)according to surgical methods.The surgical indexes(operation time,ambulation time,hospitalization time and intraoperative blood loss),clinical effect of 4 weeks after surgery,stress response indexes[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),nitric oxide(NO)]before and 3 d after surgery,coagulation function indexes[prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D)],incidence of postoperative adverse reactions and recurrence rate 1 year after surgery of the two groups were compared.Result The operation time,ambulation time,hospitalization time in the punctate group were significantly shorter than those in traditional group,intraoperative blood loss was lower than that in traditional group(P<0.01).Four weeks after surgery,the total clinical effective rate of the punctate group was significantly higher than that of the traditional group(P<0.01),and the clinical efficacy was significantly better than that of the traditional group(P<0.01).Three days after surgery,the levels of IL-6,TNF-α,NO,FIB and D-D in punctate group were lower,APTT,PT and TT were longer than those in the traditional group(P<0.05).The total incidence of postoperative complications and the recurrence rate 1 year after surgery in the punctate group were lower than those in the traditional group(P<0.05).Conclusion High ligation of great saphenous vein combined point stripping can improve the clinical efficacy of patients with varicose saphenous vein,alleviate postoperative inflammation and hypercoagulability,improve vascular endothelial function,and reduce the recurrence rate.