筋膜下穿通静脉断离联合泡沫硬化剂与大隐静脉剥脱术治疗小腿溃疡对照研究

Control study of subfascial endoscopic perforator surgery combined with foam sclerotherapy and saphenous vein stripping surgery in the treatment of leg ulcers

目的评价保留非曲张大隐静脉主干,采用腔镜深筋膜下穿通静脉断离联合泡沫硬化剂注射治疗下肢静脉性溃疡的临床疗效。方法前瞻性分析2013年1月至12月收治的65例(76条患肢)下肢静脉性溃疡患者。用Excel表简单随机分为两组:A组为腔镜联合泡沫硬化剂组,33例(39条患肢)采用腔镜小腿深筋膜下穿通静脉断离联合溃疡周围曲张静脉泡沫硬化剂注射;B组为传统大隐静脉剥脱术组,32例(37条患肢)采用传统大隐静脉高位结扎,主干及曲张静脉属支剥脱。用CEAP分级及静脉临床严重程度评分(VCSS),比较两组手术前后的变化。结果 A、B两组手术前CEAP分级及VCSS差异无统计学意义(P>0.05),A组术前VCSS(13.8±0.6)分、术后(4.8±0.9)分,A组手术前、后比较差异有统计学意义(P<0.05)。B组术前VCSS(13.7±0.5)分、术后(8.0±1.8)分,B组手术前、后比较差异有统计学意义(P<0.05)。两组手术前后VCSS差值分别为(9.0±0.9)分和(5.7±1.3)分,两组差值比较差异有统计学意义(P<0.05)。结论腔镜穿通支断离联合泡沫硬化剂注射治疗下肢静脉性溃疡,能有效地阻断溃疡区域的静脉高压淤血状态,疗效优于大隐静脉主干剥脱。下肢静脉性溃疡的发生与大隐静脉曲张无密切关系。

Objective With non varicose saphenous vein retention,to evaluate the clinical efficacy of subfascial endoscopic perforating vein disconnection combined with foam sclerotherapy for venous leg ulcer.Methods Prospective analysis of 76 limbs with venous ulcer of lower extremities(from January 2013 to December 2013) in 65 patients was carried out.All the cases were randomly divided into two groups by Excel table.Group A is endoscopic technique combined with foam sclerotherapy,33 cases(39 limbs),undergoing subfascial endoscopic perforating vein disconnection combined with foam sclerotherapy.Group B is the traditional stripping of great saphenous vein,32 cases(37 limbs),undergoing the traditional high ligation of great saphenous vein and varicose vein trunk,branches of stripping.Using CEAP score and the clinical severity score(VCSS),the changes of the two groups pre-and postoperative were compared.Results There was no significant difference in CEAP classification and VCSS score between the two groups before operation(P > 0.05).The VCSS values of groups A were 13.8 ± 0.6 and 4.8 ± 0.9 before and after operation.There was significant difference between group A before and after operation(P < 0.05).The VCSS values of groups A were 13.7 ± 0.5 and 8.0 ± 1.8 before and after operation.There was significant difference between group B before and after operation(P < 0.05).The difference of VCSS between the two groups before and after operation were(9.0 ± 0.9),(5.7 ± 1.3).The difference between the two groups was statistically significant.Conclusions Endoscopic perforator disconnection combined with foam sclerotherapy for venous ulcer of lower extremities,can effectively block the ulcer area congestion venous hypertension.The curative effect is better than that of the saphenous vein stripping.There is no close relationship between occurrence of lower extremity venous ulceration and varicose vein.