摘要
目的比较大隐静脉高位结扎术联合泡沫硬化剂注射与腔内激光联合泡沫硬化剂注射治疗下肢静脉性溃疡(VULE)的临床效果。方法选择2014年2月至2017年8月陕西省中医医院收治的80例VULE患者为研究对象,根据治疗方法将患者分为观察组和对照组,每组40例。对照组患者给予大隐静脉高位结扎术联合泡沫硬化剂注射治疗,观察组患者给予腔内激光联合泡沫硬化剂注射治疗。观察2组患者的手术时间、术中出血量、术后住院时间;术前及术后1个月,采用口诉言词评分法(VRS)对2组患者疼痛程度进行评分,采用酶联免疫吸附试验检测2组患者血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平,并测量2组患者溃疡面积;术后1个月评估2组患者的临床疗效;分别于术前、术后1个月及1 a采用生活质量普适量表(QOL-35)评估2组患者生活质量(QOL),分别于术前及术后1 a采用静脉临床严重程度评分表(VCSS)评估患者下肢静脉疾病的严重程度;所有患者术后随访2 a,观察术后并发症和VULE复发情况。结果观察组和对照组患者治疗总有效率分别为92.5%(37/40)和72.5%(29/40),观察组患者治疗总有效率高于对照组(χ^2=6.198,P <0.05)。与对照组比较,观察组患者手术时间和术后住院时间短,术中出血量少(P <0.05)。2组患者术前VRS评分比较差异无统计学意义(P> 0.05)。术后1个月,2组患者VRS评分低于术前(P <0.05);且观察组患者VRS评分低于对照组(P <0.05)。2组患者术前溃疡面积比较差异无统计学意义(P> 0.05)。术后1个月,2组患者溃疡面积显著小于术前(P <0.05);且观察组患者溃疡面积显著小于对照组(P <0.05)。2组患者术前血清TNF-α、CRP、IL-6水平比较差异无统计学意义(P> 0.05)。术后1个月,2组患者血清TNF-α、CRP、IL-6水平低于术前(P <0.05);观察组患者血清TNF-α、CRP、IL-6水平低于对照组(P <0.05)。2组患者术前VCSS评分、QOL评分比较差异无统计学意义(P> 0.05);2组患者术后1个月及1 a VCSS评分低于术前,QOL评分高于术前(P <0.05);2组患者术后1 a VCSS评分低于术后1个月,QOL评分高于术后1个月(P <0.05);术后1个月及1 a,观察组患者VCSS评分低于对照组,QOL评分高于对照组(P <0.05)。观察组和对照组患者并发症发生率分别为20.0%(8/40)和42.5%(17/40),观察组患者并发症发生率低于对照组(χ^2=3.627,P <0.05)。观察组和对照组患者术后2 a内VULE复发率分别为5.0%(2/40)和12.5%(5/40),观察组患者术后2 a内VULE复发率低于对照组(χ^2=3.051,P <0.05)。结论与大隐静脉高位结扎术联合泡沫硬化剂注射相比,腔内激光联合泡沫硬化剂注射治疗可以加快VULE患者溃疡愈合,降低机体炎症反应,提高治疗效果,改善患者的QOL,且并发症发生率和VULE复发率低。
Objective To compare the clinical effect between high ligation of great saphenous vein combined with foam sclerotherapy and intracavitary laser therapy combined with foam sclerotherapy in the treatment of venous ulcer of lower extremity(VULE).Methods Eighty patients with VULE admitted to Shaanxi Traditional Chinese Medicine Hospital from February 2014 to August 2017 were selected as the subjects.The patients were divided into observation group and control group according to the treatment method,with 40 cases in each group.The patients in the control group were treated with high ligation of great saphenous vein combined with foam sclerotherapy,while the patients in the observation group were treated with intracavity laser therapy combined with foam sclerotherapy.The operation time,intraoperative bleeding volume and postoperative hospitalization time of the patients in the two groups were observed.Before and at one month after operation,the pain of the patients in the two groups was evaluated by verbal rating scales(VRS),the levels of serum tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and interleukin-6(IL-6)were detected by enzyme linked immunosorbent assay,and the ulcer area was measured.The clinical effect of the patients in the two groups was evaluated at one month after operation.The quality of life(QOL)was assessed by QOL-35 at the time points of before operation,at one month after operation and at one year after operation.The severity of venous diseases of lower extremity was assessed by venous clinical severity score(VCSS)before and at one year after operation.All patients were followed up for two years to observe the postoperative complications and VULE recurrence.Results The total effective rate in the observation group and the control group was 92.5%(37/40)and 72.5%(29/40),respectively.The total effective rate in the observation group was higher than that in the control group(χ2=6.198,P<0.05).Compared with the control group,the patients in the observation group had shorter operation time and postoperative hospitalization time and less intraoperative bleeding volume(P<0.05).There was no significant difference in preoperative VRS score between the two groups(P>0.05).The VRS score of the patients at one month after operation was lower than that before operation in the two groups(P<0.05).The VRS score of the patients in the observation group was lower than that in the control group at one month after operation(P<0.05).There was no significant difference in ulcer area between the two groups before operation(P>0.05).The ulcer area of the patients at one month after operation was significantly smaller than that before operation in the two groups(P<0.05).The ulcer area of the patients in the observation group was significantly lower than that in the control group at one month after operation(P<0.05).There was no significant difference in the levels of serum TNF-α,CRP and IL-6 between the two groups before operation(P>0.05).The levels of serum TNF-α,CRP and IL-6 at one month after operation were lower than those before operation in the two groups(P<0.05).The levels of serum TNF-α,CRP and IL-6 in the observation group were lower than those in the control group at one month after operation(P<0.05).There was no significant difference in the VCSS score and QOL score between the two groups before operation(P>0.05).Compared with that before operation,the VCSS score in the two groups was lower and QOL score was higher at one month and one year after operation(P<0.05).Compared with one month after operation,the VCSS score was higher and QOL score was higher in the two groups at one year after operation(P<0.05).At one month and one year after the operation,the VCSS score in the observation group was lower than that in the control group,and the QOL score was higher than that in the control group(P<0.05).The incidence of complications in the observation group and the control group was 20.0%(8/40)and 42.5%(17/40),respectively.The incidence of complications in the observation group was lower than that in the control group(χ2=3.627,P<0.05).The 2-year recurrence rate of VULE in the observation group and the control group was 5.0%(2/40)and 12.5%(5/40),respectively.The 2-year recurrence rate of VULE in the observation group was lower than that in the control group(χ^2=3.051,P<0.05).Conclusion Compared with the high ligation of great saphenous vein combined with foam sclerotherapy,the intracavity laser therapy combined with foam sclerotherapy can accelerate ulcer healing,reduce the inflammatory reaction,improve the treatment effect and the QOL of patients with VULE,and the incidence of complications and VULE recurrence rate are low.
作者
张海鹏
侯翔波
董海军
贾杉
ZHANG Haipeng;HOU Xiangbo;DONG Haijun;JIA Shan(Department of Surgery,Shaanxi Traditional Chinese Medicine Hospital,Xi′an 710003,Shaanxi Province,China)
出处
《新乡医学院学报》
CAS
2020年第6期574-579,共6页
Journal of Xinxiang Medical University
关键词
下肢静脉性溃疡
大隐静脉高位结扎
腔内激光
泡沫硬化剂
venous ulcer of lower extremity
high ligation of great saphenous vein
Intracavitary laser therapy
foam sclerotherapy
作者简介
张海鹏(1980-),男,陕西榆林人,学士,主治医师,研究方向:普通外科疾病的诊断与治疗;通信作者:侯翔波(1988-),男,山西临汾人,硕士,主治医师,研究方向:普通外科疾病的诊断与治疗,E-mail:113574523@qq.com。
