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分组治疗的共 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)。所有患者均成功接受手术。单纯硬化剂组的中位手术时间和术中平均失血量均明显低于联合治疗组[14 min 比 40 min,P<0.001;(12.3±3.2)mL 比(35.5±10 )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]。2 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 ulcers. 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=27). Results The baseline data such as the age, gender, disease duration, ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operation 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) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection rate, 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 combined 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). No large area of tissue necrosis, the deep vein thrombosis, and 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 ulcers can accelerate ulcer healing than sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group was superior in the time and cost of hospitalization, the appropriate treatment plan should be formulated according to the specific situation of the patient.

关键词: 大隐静脉结扎剥脱联合泡沫硬化剂; 单纯泡沫硬化剂; 下肢静脉性溃疡

Key words: ligation and stripping of great saphenous vein in combination with foam sclerotherapy; foam sclerotherapy alone; venous leg ulcers

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1. McLafferty RB, Passman MA, Caprini JA, et al. Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program. J Vasc Surg, 2008, 48(2): 394-399.
2. Ghauri AS, Taylor MC, Deacon JE, et al. Influence of a specialized leg ulcer service on management and outcome. Br J Surg, 2000, 87(8): 1048-1056.
3. Bergqvist D, Lindholm C, Nelzén O. Chronic leg ulcers: the impact of venous disease. J Vasc Surg, 1999, 29(4): 752-755.
4. Rice JB, Desai U, Cummings AK, et al. Burden of venous leg ulcers in the United States. J Med Econ, 2014, 17(5): 347-356.
5. Purwins S, Herberger K, Debus ES, et al. Cost-of-illness of chronic leg ulcers in Germany. Int Wound J, 2010, 7(2): 97-102.
6. Rabe E, Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology, 2010, 25 Suppl 1: 64-67.
7. O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev, 2012, 11: CD000265.
8. Bello YM, Phillips TJ. Therapeutic dressings. Adv Dermatol, 2000, 16: 253-271.
9. 高荐辕, 金辉. 下肢静脉性溃疡诊治进展. 中国实用外科杂志, 2015, 35(12): 1355-1358.
10. Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins. Dermatol Surg, 2001, 27(1): 58-60.
11. 美国静脉论坛CEAP分级国际特别委员会. 共识报告——慢性静脉病变CEAP分级法的修订. 中华外科杂志, 2006. 44(1): 59-61.
12. Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med, 1997, 12(6): 374-383.
13. Etufugh CN, Phillips TJ. Venous ulcers. Clin Dermatol, 2007, 25(1): 121-130.
14. Partsch H, Flour M, Smith PC, et al. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol, 2008, 27(3): 193-219.
15. Coleridge-Smith PD. Leg ulcer treatment. J Vasc Surg, 2009, 49(3): 804-808.
16. Kheirelseid EA, Bashar K, Aherne T, et al. Evidence for varicose vein surgery in venous leg ulceration. Surgeon, 2016, 14(4): 219-233.
17. Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet, 2004, 363(9424): 1854-1859.
18. van Gent WB, Catarinella FS, Lam YL, et al. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology, 2015, 30(1 Suppl): 35-41.
19. Linton RR. The post-thrombotic ulceration of the lower extremity: its etiology and surgical treatment. Ann Surg, 1953, 138(3): 415-433.
20. Marston WA. Efficacy of endovenous ablation of the saphenous veins for prevention and healing of venous ulcers. J Vasc Surg Venous Lymphat Disord, 2015, 3(1): 113-116.
21. Disselhoff BC, der Kinderen DJ, Kelder JC, et al. Five-year results of a randomised clinical trial of endovenous laser ablation of the great saphenous vein with and without ligation of the saphenofemoral junction. Eur J Vasc Endovasc Surg, 2011, 41(5): 685-690.
22. Campos W Jr, Torres IO, da Silva ES, et al. A prospective randomized study comparing polidocanol foam sclerotherapy with surgical treatment of patients with primary chronic venous insufficiency and ulcer. Ann Vasc Surg, 2015, 29(6): 1128-1135.
23. Li X, Fan L, Ren S, et al. Outcomes of foam sclerotherapy plus ligation versus foam sclerotherapy alone for venous ulcers in lower extremities. Ann Vasc Surg, 2017, 45: 160-165.
24. Reich-Schupke S, Weyer K, Altmeyer P, et al. Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5% foam. Vasa, 2010, 39(2): 169-174.
25. Georgiev M. Postsclerotherapy hyperpigmentations: a one-year follow-up. J Dermatol Surg Oncol, 1990, 16(7): 608-610.
26. Rabe E, Breu FX, Cavezzi A, et al. European guidelines for sclerotherapy in chronic venous disorders. Phlebology, 2014, 29(6): 338-354.
27. 陈镜全, 曾国军, 王洪, 等. 大隐静脉高位结扎加剥脱术中两种皮肤缝线的效果比较. 2017, 24(5): 593-598.