中国普外基础与临床杂志

中国普外基础与临床杂志

大隐静脉结扎剥脱联合泡沫硬化剂与单纯泡沫硬化剂治疗下肢静脉性溃疡的疗效比较

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目的 研究并比较大隐静脉结扎剥脱术联合泡沫硬化剂与单纯泡沫硬化剂疗法对下肢静脉性溃疡的疗效。 方法 回顾性分析四川大学华西医院 2015 年 1 月至 2016 年 12 月期间采用上述方法治疗的共 57 例下肢静脉性溃疡患者的临床资料,其中有 33 例患者接受大隐静脉结扎剥脱术联合泡沫硬化剂治疗(简称联合治疗组),24 例患者接受单纯泡沫硬化剂治疗(简称单纯硬化剂组)。 结果 2 组患者在年龄、性别、病程、溃疡大小等基线资料比较差异均无统计学意义(P>0.05)。所有患者的手术均成功。单纯硬化剂组的中位手术时间和术中平均失血量明显短或少于联合治疗组 [分别为:14 min 比 40 min,P<0.001;(12.3±3.2)mL 比(35.5±10.0 )mL,P<0.001],但单纯硬化剂组的术后溃疡愈合时间明显长于联合治疗组 [(22.0±4.5) d 比 (13.7±4.0) d,P<0.001]。单纯硬化剂组和联合治疗组患者术后伤口感染、局部色素沉着及溃疡复发率比较差异均无统计学意义(分别为:4.2% 比 9.1%,P=0.472;25.0% 比 15.2%,P=0.352;20.8% 比 9.1%,P=0.208)。在中位住院时间及费用上单纯硬化剂组明显少于联合治疗组(分别为: 4 d 比 13 d,P<0.001;3 000 元比 8 590 元,P<0.001)。2 组患者术后均未发生下肢深静脉血栓形成、大面积组织坏死等严重并发症。 结论 大隐静脉结扎剥脱联合泡沫硬化剂治疗下肢静脉性溃疡较单纯泡沫硬化剂治疗可加快溃疡愈合,在并发症及复发率方面二者未见明显统计学差异,单纯泡沫硬化剂治疗在住院时间及费用上更有优势,临床上应根据患者个体情况制定合适的治疗方案。

Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.

关键词: 大隐静脉结扎剥脱; 泡沫硬化剂; 下肢静脉性溃疡

Key words: ligation and stripping of great saphenous vein; foam sclerotherapy; venous leg ulcer

引用本文: 曾彦彰, 杨轶, 赵纪春. 大隐静脉结扎剥脱联合泡沫硬化剂与单纯泡沫硬化剂治疗下肢静脉性溃疡的疗效比较. 中国普外基础与临床杂志, 2018, 25(3): 312-316. doi: 10.7507/1007-9424.201709081 复制

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