腔内微创手术与传统手术治疗下肢静脉曲张的临床效果对比

Effect comparison between minimally invasive and traditional surgery in the treatment of varicose veins of the lower extremity

目的 探讨腔内微创手术与传统手术治疗下肢静脉曲张的疗效。方法 收集2018年3月至2022年3月于山西省长治市上党区中医院和上海交通大学医学院附属第六人民医院就诊的370例下肢静脉曲张患者的临床资料,按照治疗方法的不同将其分为射频消融组(n=120,行大隐静脉射频闭合联合点式剥脱及泡沫硬化剂治疗)、激光消融组(n=110,行大隐静脉激光闭合联合点式剥脱及泡沫硬化剂治疗)和传统手术组(n=140,行大隐静脉高位结扎联合点式剥脱及泡沫硬化治疗),比较各组患者的手术情况、术后视觉模拟量表(VAS)评分、静脉临床严重程度评分(VCSS)、术后并发症及再次治疗率。结果 射频消融组、激光消融组患者切口数量、术中出血量均少于传统手术组患者,手术时间、术后住院时间均短于传统手术组患者,术后24 h VAS评分均低于传统手术组患者,差异均有统计学意义(P﹤0.05)。3组患者首次下床时间比较,差异均无统计学意义(P﹥0.05)。3组患者术前、术后6个月VCSS比较,差异均无统计学意义(P﹥0.05)。术后6个月,3组患者VCSS均低于本组术前,差异均有统计学意义(P﹤0.05)。3组患者隐神经损伤、患肢牵拉感、皮下血肿、切口感染及皮肤瘀斑发生率比较,差异均无统计学意义(P﹥0.05)。术后随访12个月,3组患者小腿残留曲张静脉条数、大隐静脉主干再通率及再次治疗率比较,差异均无统计学意义(P﹥0.05)。结论 腔内微创手术治疗下肢静脉曲张静脉的临床效果、并发症发生率与传统手术治疗相似,但微创治疗下肢静脉曲张具有创伤小、恢复快等优势,值得临床进一步推广应用。

Objective To explore the clinical outcomes of intraluminal minimal invasive surgery versus traditional surgery in the treatment of varicose veins of the lower extremity.Method The data of 370 patients with varicose veins of lower extremity who were treated in the Traditional Chinese Medical Hospital of Shangdang District and Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2018 to March 2022 were collected.The patients were divided into radiofrequency ablation group(n=120,received radiofrequency closure of great saphenous vein+punctate stripping and foam sclerotherapy),laser ablation group(n=110,received laser closure of great saphenous vein+punctate stripping and foam sclerotherapy)and traditional operation group(n=140,received high ligation of great saphenous vein+punctate stripping and foam sclerotherapy)according to different treatment methods.The surgery conditions,postoperative scores of visual analogue scale(VAS),venous clinical severity score(VCSS),postoperative complications and cure rate were compared among the three groups.Result The number of incisions and intraoperative bleeding in the radiofrequency ablation group and laser ablation group were lower than those in the traditional surgery group,the surgical time and postoperative hospital stay were shorter than those in the traditional surgery group,the postoperative VAS score at 24 hours was lower than that in the traditional surgery group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the first time of getting out of bed among the three groups of patients(P>0.05).There were no significant differences for the preoperative and 6-month postoperative VCSS scores in the three groups(P>0.05);6 months after surgery,VCSS in 3 groups were lower than their before surgery(P<0.05).There were no significant differences in the incidence of saphenous nerve injury,pulling sensation of affected extremity,subcutaneous hematoma,incision infection and skin ecchymosis among three groups(P>0.05).After 12 months of follow-up,there were no significant differences in the number of residual varicose veins in the lower extremity,the revascularization of the great saphenous vein and the re-treatment rate among the three groups(P>0.05).Conclusion Intraluminal minimal invasive surgery can achieve comparable clinical effect and complication rate with traditional surgery,but it presents minimal invasion and rapid recovery in the treatment of varicose veins of lower extremity.