不同微创方式治疗下肢静脉曲张的临床疗效比较

doi:10.13481/j.1671-587x.20180232

吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (02): 383-387.doi: 10.13481/j.1671-587x.20180232

不同微创方式治疗下肢静脉曲张的临床疗效比较

姜海军¹, 张弘¹, 杨植¹, 赵博², 刘彦春¹, 杜建青¹, 尹晶¹

1. 承德医学院附属医院血管普外科, 河北承德 067000;
2. 承德医学院附属医院输血科, 河北承德 067000

收稿日期:2017-08-07 出版日期:2018-03-28 发布日期:2018-03-30
通讯作者: 姜海军,主治医师(Tel:0314-2270907,E-mail:haijunzhanshi8@163.com) E-mail:haijunzhanshi8@163.com
作者简介:姜海军(1983-),男,河北省围场县人,主治医师,医学硕士,主要从事血管和普外科常见疾病诊治方面的研究。
基金资助:
河北省卫计委自然科学基金资助课题（H2016706024）；河北省承德市科技局科技支撑计划项目资助课题（201601A027）

Comparison of curative effects between different minimally invasive methods in treatment of varicose veins in lower extremities

JIANG Haijun¹, ZHANG Hong¹, YANG Zhi¹, ZHAO Bo², LIU Yanchun¹, DU Jianqing¹, YIN Jing¹

1. Department of General Surgery, Affiliated Hospital, Chengde Medical College, Chengde 067000, China;
2. Department of Blood Transfusion, Affiliated Hospital, Chengde Medical College, Chengde 067000, China

Received:2017-08-07 Online:2018-03-28 Published:2018-03-30

摘要/Abstract

摘要： 目的：比较不同微创手术方式治疗下肢静脉曲张的临床疗效，探讨其临床价值。方法：选择201例下肢静脉曲张患者，采用不同的治疗方式，其中腔内激光灼闭术（EVLA）组52例、透光旋切术（TIPP）组46例、EVLA联合腔镜下交通支离断术（SEPS）（EVLA+SEPS）组49例和TIPP+SEPS组54例。比较各组患者手术时间、术中出血量、术后住院费用、住院时间以及术后并发症（残留静脉曲张、皮下硬结、浅静脉炎、隐神经损伤、瘀斑、伤口血肿、皮肤麻木和下肢肿胀）的发生率。结果：各组患者手术时间、术中出血量及术后住院时间和住院费用比较差异均有统计学意义（P<0.05）。与EVLA组比较，TIPP组患者残留静脉曲张、浅静脉炎、下肢肿胀和瘀斑发生率降低（P<0.05）；皮下硬结、伤口血肿、隐神经损伤和皮肤麻木发生率略高，但差异无统计学意义（P>0.05）；与EVLA组和TIPP组比较，EVLA+SEPS组和TIPP+SEPS组残留静脉曲张和浅静脉炎发生率下降（P<0.05）。与EVLA组比较，TIPP组、EVLA+SEPS组和TIPP+SEPS组术后3个月愈合率明显升高（P<0.05）；TIPP组、EVLA+SEPS组和TIPP+SEPS组术后1年复发率明显降低（P<0.05）。结论：EVLA联合SEPS和TIPP联合SEPS治疗下肢静脉曲张的疗效优于单独EVLA和TIPP治疗方法，具有安全可靠、曲张静脉切除彻底、溃疡愈合快及复发率低等优点。

关键词: 腔镜下交通支离断术, 静脉曲张, 腔内激光灼闭术, 透光旋切术

Abstract: Objective:To compare the clinical effects of different minimally invasive surgeries in the treatment of varicose veins of lower extremities,and to explore their application values. Methods: A total of 201 patients with varicose veins of lower extremities were selected and treated with different operation methods.52 cases were treated by endovenous laser therapy(EVLA group),46 cases were treated by transilluminated powered phlebectomy(TIPP group),49 cases were treated by EVLA combined subfascial endoscopic perforator surgery (SEPS)(EVLA+SEPS group) and 54 cases were treated by TIPP combined SEPS (TIPP+SEPS)group.The operation time,the intraoperative blood loss,the postoperative hospitalization cost,the hospitalization time,the incidence rates of postoperative complications (residual varicose veins,subcutaneous induration,superficial phlebitis,skin necrosis and saphenous nerve injury) of the patients in various groups were compared. Results: There were significant differences in the operation time,the intraoperative blood loss and the postoperative hospitalization time,the hospitalization cost of the patients between various groups(P<0.05).Compared with EVLA group,the incidence rats of residual varicose veins,superficial phlebitis,and lower extremity swelling and ecchymosis of the patients in TIPP group were significantly decreased (P<0.05); the incidence rates of subcutaneous induration,wound hematoma,saphenous nerve injury and skin numbness were increased,but there were no significant differences (P>0.05).Compared with EVLA group and TIPP group,the incidence rates of reidual varicose veins and superficial phlebitis in EVLA + SEPS group and TIPP + SEPS group were significantly decreased (P<0.05).The healing rates of the patients 3 months after operation in TIPP group,EVLA + SEPS group and TIPP + SEPS group were significantly increased compared with EVLA group(P<0.05).The recurrence rates 1 year after operation in TIPP group,EVLA + SEPS group and TIPP + SEPS group were lower than that in EVLA group (P<0.05). Conclusion: The curative effects of EVLA combined with SEPS and TIPP combined with SEPS in treatment of varicose veins in lower extremities are superior to EVLA and TIPP,with the advantages of safe and reliable methods,complete varicose vein resection,less postoperative complications,quick ulcer healing and low recurrence rate and so on.

Key words: transilluminated powered phlebectomy, varicose veins, subfascial endoscopic perforator surgery, endovenous laser therapy

中图分类号:

R543.6

姜海军, 张弘, 杨植, 赵博, 刘彦春, 杜建青, 尹晶. 不同微创方式治疗下肢静脉曲张的临床疗效比较[J]. 吉林大学学报(医学版), 2018, 44(02): 383-387.

JIANG Haijun, ZHANG Hong, YANG Zhi, ZHAO Bo, LIU Yanchun, DU Jianqing, YIN Jing. Comparison of curative effects between different minimally invasive methods in treatment of varicose veins in lower extremities[J]. Journal of Jilin University Medicine Edition, 2018, 44(02): 383-387.

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不同微创方式治疗下肢静脉曲张的临床疗效比较

Comparison of curative effects between different minimally invasive methods in treatment of varicose veins in lower extremities

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