摘要
目的探讨综合方式处理难治性下肢静脉性溃疡(venous leg ulcers,VLUs)的效果。方法以综合方式(大隐静脉高位结扎+曲张静脉硬化剂注射+压力治疗,Compression plus HL-EVLA-FS)治疗的76例下肢难治性VLUs为观察组,以传统方式(大隐静脉高位结扎+曲张静脉抽剥+压力治疗,Compression plus HL-S)治疗的76例下肢难治性VLUs为对照组。随访1年,比较溃疡愈合率、曲张静脉(varicose veins,VVs)的闭合率、手术时间、术中出血量、静脉临床严重程度评分(venous clinical severity score,VCSS)变化和并发症。结果对照组和观察组的溃疡愈合时间分别为(2.4±2.2)个月和(1.3±0.9)个月,观察组溃疡愈合时间更短,差异有统计学意义(P<0.05)。两组累积溃疡愈合率差异有统计学意义[风险比(hazard ratio,HR)和95%置信区间(confidence interval,CI)分别为1.584和1.128~2.225,P=0.008]。VVs闭合率差异无统计学意义(HR和95%CI分别为0.970和0.682~1.380,P=0.865)。两组患者的手术时间、术中出血量、术后6个月和12个月VCSS变化和部分并发症(隐神经损伤、浅静脉炎)差异有统计学意义(P<0.05)。结论对于难治性下肢静脉性溃疡,Compression plus HL-EVLA-FS的综合治疗方式可以加速VLUs的愈合,改善患者术后VCSS,手术时间短、出血量少。然而,与传统的Compression plus HL-S治疗方式相比,综合治疗方式在曲张静脉的闭合率上却无明显优势。
Objective To investigate the effect of high ligation-endovenous laser ablation-foam sclerotherapy followed with compression(compression plus HL-EVLA-FS) on the treatment of refractory lower limb venous legs ulcers(VLUs). Methods Data of the refractory VLUs treated by comprehensive therapy(compression plus HL-EVLA-FS) and 1-year follow-up were collected from 2016 to 2018(observation group), and compared with the data of refractory VLUs from 2013 to 2015 treated with traditional therapy(compression plus HL-S) and 1-year follow-up(control group). The ulcer healing rate, VVs occlusion rate, operation duration, bleeding volume, venous clinical severity score(VCSS) and complications such as saphenous nerve injury and superficial phlebitis were recorded for comparison. Results The mean ulcer healing time was 2.4±2.2 months and 1.3±0.9 months in control group and observation group, respectively;which was significantly shorter in observation group(P<0.05). Cumulative ulcer healing rates were significantly different between the two groups(P=0.008). However, there was no significant difference in the VVs occlusion rate(P=0.865). Significant differences were found in 6 months and 12 months post-operatively in the VCSS change, operation duration, bleeding volume, and the complications of saphenous nerve injury and superficial phlebitis between the two groups. Conclusion The treatment mode of compression plus HL-EVLA-FS can accelerate the VLUs healing, improve the postoperative VCSS of patients with refractory VLUs, shorten the operation time and reduce the bleeding volume. However, the method of compression plus HL-EVLA-FS had no significant advantage over the method of compression plus HL-S in the VVs occlusion.
作者
朱作银
肖丽萍
刘小春
朱建华
钟健
廖金石
ZHU Zuo-yin;XIAO Li-ping;LIU Xiao-chun;ZHU Jian-hua;ZHONG Jian;LIAOShi-jin(Second Department of Surgery,Nankang District of Ganzhou City Hospital of Traditional Chinese Medicine,Ganzhou 341400,Jiangxi,China)
出处
《广东医学》
CAS
2020年第1期45-50,共6页
Guangdong Medical Journal
基金
赣州市指导性科技计划项目(GZ2018ZSF505)
江西省卫生健康委科技计划项目(20202086)
关键词
下肢静脉曲张
溃疡
难治性
联合治疗
varicose veins
venous leg ulcers
refractory
comprehensive treatment
