摘要
目的评估超声引导下泡沫硬化疗法(UGFS)联合大隐静脉(GSV)高位结扎术治疗重度下肢静脉曲张(CEAP分级C4~C6级)的临床效果。方法纳入2015年1月-2019年1月解放军联勤保障部队第928医院收治的354例原发性GSV功能不全患者(CEAP分级C4~C6级),随机采用UGFS治疗(164例)或手术治疗(190例)。UGFS治疗患者在超声引导下行GSV高位结扎联合UGFS治疗,手术治疗患者进行GSV高位结扎剥脱术或透光动力旋切术治疗,治疗后1、6和12个月进行随访,排除不依从治疗及失访患者76例,最终纳入278例,其中UGFS治疗130例(UGFS组),手术治疗148例(对照组)。比较两组的手术时间、反流复发率、与手术相关的不良事件、血流动力学参数、治疗费用及生活质量。结果术后12个月,两组累积反流复发率(13.8%vs.13.5%)、轻度并发症发生率(27.7%vs.21.6%)和重度并发症发生率(3.1%vs.2.7%)比较,差异均无统计学意义(P>0.05)。与治疗前相比,治疗后两组静脉充盈指数及静脉临床严重程度评分表(VCSS)、阿伯丁静脉曲张问卷(AVVQ)评分均得到明显改善(P<0.05)。与对照组相比,UGFS组手术时间和恢复时间短[(38.27±7.49)min vs.(81.17±8.08)min,P<0.05;(5.40±1.28)d vs.(9.61±2.81)d,P<0.05],治疗费用低[(0.56±0.13)万元vs.(1.20±0.21)万元,P<0.05]。术后12个月,两组患者满意度差异无统计学意义(89.2%vs.92.3%,P>0.05)。结论UGFS联合GSV高位结扎术治疗严重下肢静脉曲张临床疗效确切,手术时间和恢复时间短,血流动力学参数改善明显,治疗费用低,值得临床推广应用。
Objective To evaluate the clinical effect of ultrasound guided foam sclerotherapy(UGFS)combined with high ligation of great saphenous vein(GSV)in treatment of severe varicose veins of lower extremity(grade C4-C6).Methods A total of 354 patients with primary GSV dysfunction(CEAP classification C4-C6)were recruited to the 928 Hospital of the PLA Joint Logistic Support Force from January 2015 to January 2019,and randomly treated with UGFS(164 cases),or surgical treatment(190 cases).Patients in UGFS group received UGFS with high ligation of GSV,and in surgical treatment group received high ligation and stripping of GSV or TIPP.Follow-up was conducted at 1,6 and 12 months after treatment.By exclusion of non-compliance and loss of follow-up patients(76 cases),278 cases were finally included,including 130 patients of UGFS group and 148 patients from control group.Operative time,reflux recurrence rate,surgical-related adverse events,hemodynamic parameters,treatment costs,and quality of life were compared between the two groups.Results No significant difference existed between UGFS group and control group 12 months after treatment on the cumulative recurrence rate(13.8%vs.13.5%,P>0.05),and the incidence of mild complications(27.7%vs.21.6%,P>0.05)and severe complications(3.1%vs.2.7%,P>0.05).Compared with those before treatment,venous filling index,venous clinical severity score(VCSS)and Aberdeen varicose vein questionnaire(AVVQ)scores were significantly improved after treatment in both groups(P<0.05).Compared with the control group,the average operation time and recovery time were shorter in UGFS group[(38.27±7.49)min vs.(81.17±8.08)min,P<0.05;(5.40±1.28)d vs.(9.61±2.81)d,P<0.05],and the average treatment cost was significantly lower[(5600±1300)yuan vs.(12000±2100)yuan,P<0.05].Twelve months after the operation,there was no significant difference in patient satisfaction between UGFS group and control group(89.2%vs.92.3%,P>0.05).Conclusion UGFS combined with GSV high ligation for the treatment of severe varicose veins in the lower extremity has a definite clinical curative effect,short operation time and recovery time,obvious improvement of hemodynamic parameters,and low treatment cost,so is worthy of clinical popularization and application.
作者
朱玲玲
戴慧勇
张海鹰
Zhu Ling-Ling;Dai Hui-Yong;Zhang Hai-Ying(Department of Ultrasound,the 928 Hospital of the PLA Joint Logistic Support Force,Haikou 520000,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2020年第12期1288-1293,共6页
Medical Journal of Chinese People's Liberation Army
关键词
超声引导
泡沫硬化疗法
大隐静脉高位结扎术
静脉曲张
ultrasound-guided
foam sclerotherapy
high ligation of the great saphenous vein
varicose veins
