大隐静脉高位结扎、腔内激光联合经皮缝扎术对中重度下肢静脉曲张的治疗效果分析

Effect of high ligation of great saphenous vein,endovenous laser combined with percutaneous ligation on moderate and severe varicose veins of lower extremity

目的探讨大隐静脉高位结扎、腔内激光联合经皮缝扎术对中重度下肢静脉曲张(VVLE)的治疗效果。方法选取2019年1月—2020年12月期间本院收治的105例中重度VVLE患者作为研究对象,随机分为静脉高位结扎+剥脱术组35例(A组)、静脉高位结扎+腔内激光治疗35例(B组)、静脉高位结扎+腔内激光治疗+经皮缝扎术35例(C组)。比较3组的围手术期资料、手术安全性及复发状况。结果全部患者的静脉曲张相关症状均显著缓解,A组患者手术时间、术中失血量、术后下床时间、平均住院天数、术后3 d的VAS评分显著高于另外两组,B组术后下床时间、平均住院天数、术后3 d的VAS评分显著高于C组,差异有统计学意义(均P<0.05)。安全性方面,A组肢体肿胀、皮肤感觉麻木、切口愈合不良的发生率显著高于C组,A组切口愈合不良的发生率显著高于B组,B组皮肤感觉麻木的发生率显著高于C组,差异有统计学意义(均P<0.05)。全部患者出院后均进行定期随访,中位随访时间为13.5个月(范围7~22个月),A组、B组分别有2例、1例出现VVLE复发,C组无1例复发,3组复发率比较,差异无统计学意义(P>0.05)。结论大隐静脉高位结扎、腔内激光联合经皮缝扎术对中重度VVLE的疗效显著,手术创伤小,术后恢复快,且安全性较高,可在临床推广应用。

Objective To investigate the effect of high ligation of great saphenous vein,endovenous laser combined with percutaneous ligation on moderate and severe varicose veins of lower extremity(VVLE).Methods One hundred and five patients with moderate and severe VVLE in our hospital from January 2019 to December 2020 were enrolled for the research and randomly divided into A group(high ligation of vein+stripping,n=35),B group(high ligation of vein+endovascular laser treatment,n=35),and C group(high ligation of vein+endovenous laser treatment+percutaneous ligation,n=35).The perioperative data,surgical safety and recurrence of the three groups were compared.Results Varicose related symptoms of all patients were significantly relieved.The operation time,intraoperative blood loss,postoperative ambulation time,average length of hospital stay and visual analogue scale(VAS)score of A group were significantly higher than those of the other two groups,and postoperative ambulation time,average length of hospital stay and VAS score of B group were significantly higher than those of C group(P<0.05).In terms of safety,the incidences of limb swelling,skin numbness and poor wound healing in A group were significantly higher than that in C group,and the incidence of poor wound healing in A group was significantly higher than that in B group,and the incidence of skin numbness in B group was significantly higher than that in C group(P<0.05).All patients were followed up regularly after discharge,and the median follow-up time was 13.5 months(range,7-22 months).Two cases and one case in group A and group B suffered from VVLE recurrence respectively,and there was no recurrence in group C.There was no significant difference in recurrence rate among three groups(P>0.05).Conclusion High ligation of great saphenous vein,endovenous laser combined with percutaneous ligation has significant curative effect for moderate and severe VVLE.It has small surgical trauma,fast postoperative recovery and high safety,which is worthy of clinical application.