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