摘要
目的评价内镜筋膜下交通静脉离断术(subfascial endoscopic perforator surgery,SEPS)治疗重度下肢静脉曲张的临床效果。方法前瞻性单中心随机对照试验。2012年6月~2014年11月,将60例重度下肢静脉曲张(CEAP分类C5或C6)随机分为A组和B组,每组30例。A组采取传统的大隐静脉高位结扎并剥脱术,B组行SEPS+传统大隐静脉高位结扎并剥脱术。术后随访4年,随访内容包括术后并发症、溃疡复发及静脉临床严重度评分(Venous Clinical Severity Score,VCSS)。结果 2组术后下肢浅静脉曲张消失,活动性溃疡全部愈合。A组术后皮下血肿1例,皮肤淤血2例,随访率90. 0%(27/30),术后4年下肢溃疡复发率25. 9%(7/27),VCSS评分由术前的(13. 2±2. 7)下降至(6. 1±1. 4)(t=12. 687,P=0. 000)。B组术后胫前麻木2例,皮肤淤血1例,随访率93. 3%(28/30),术后4年下肢溃疡复发率21. 4%(6/28),VCSS评分由术前(13. 6±2. 7)下降至(6. 2±1. 4)(t=13. 041,P=0. 000)。2组术后并发症发生率、术后4年溃疡复发率和VCSS评分差异无统计学意义(P> 0. 05)。结论大隐静脉高位结扎并剥脱术附加SEPS治疗重度下肢静脉曲张疗效满意,但并不优于单独行大隐静脉高位结扎并剥脱术。
Objective To evaluate the clinical effect of subfascial endoscopic perforator surgery (SEPS) for severe lower extremity varicose veins. Methods A prospective, single center, randomized controlled trial was conducted. From June 2012 to November 2014, 60 patients with severe lower extremity varicose veins (CEAP grade C5 or C6) were randomly divided into group A or group B, with 30 patients in each group. The group A was treated with traditional high ligation and stripping of great saphenous vein, while the group B underwent additional SEPS operation on the basis of traditional operation. All the patients were followed up for 4 years after surgery. The follow-up visits included postoperative complications, ulcer recurrence and venous clinical severity score (VCSS). Results The varicose veins of lower extremities disappeared and active ulcer healed after operation in both groups. In the group A, there were 1 case of subcutaneous hematoma and 2 cases of skin ecchymosis. The follow-up rate was 90.0%(27/30). At 4 years after surgery, the lower limb ulcer recurrence rate was 25.9%(7/27), and the VCSS score was decreased from preoperative (13.2± 2.7) to (6.1±1.4)( t =12.687, P =0.000). In the group B, there were 2 case of anterior tibial numbness and 1 case of skin ecchymosis. The follow-up rate was 93.3%(28/30). At 4 years after surgery, the lower limb ulcer recurrence rate was 21.4%(6/28), and the VCSS score was decreased from preoperative (13.6±2.7) to (6.2±1.4)( t =13.041, P =0.000). There were no significant differences in the incidence of postoperative complications, the ulcer recurrence rate, and the VCSS score between the two groups at 4 years after operation( P>0.05 ). Conclusion High ligation and stripping of great saphenous vein plus SEPS operation is effective for severe varicose veins of lower extremity, but it is not superior to single saphenous vein ligation and stripping.
作者
侯振宇
谢爽
李亚楠
吕金利
李雪平
马志勇
Hou Zhenyu;Xie Shuang;Li Yanan(Department of General Surgery, Joint Logistics Support Force 988 Hospital of PLA, Zhengzhou 450007, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第7期580-582,596,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
静脉曲张
下肢
内镜筋膜下交通静脉离断术
前瞻性随机对照研究
Varicose veins
Lower extremity
Subfascial endoscopic perforator surgery
Prospective randomized controlled trial
