摘要
背景:既往评价手术治疗下肢慢性静脉功能不全的效果时,往往只注重于评估症状、体征的改善,而忽视患者生活质量所得到的改善。目的:评估下肢慢性静脉功能不全患者手术前后生活质量的变化。设计:对比观察,量表评估,1年追踪随访。单位:上海第二医科大学仁济医院血管外科。对象:选择2001-07/2003-12在上海第二医科大学仁济医院血管外科经手术治疗并完成1年随访的下肢慢性静脉功能不全患者169例(209侧下肢),男89例,女80例;平均年龄(56±13)岁;平均病程(11±3)年。均对治疗方案和评估项目知情同意。方法:依据逆流涉及的范围及是否存在深静脉瓣膜功能不全,分别施行3种术式:浅静脉术式组行大隐静脉高位结扎与剥脱术,46例56侧肢体;交通静脉术式组行大隐静脉高位结扎与剥脱术+交通静脉结扎术,73例87侧肢体;深静脉术式组行大隐静脉高位结扎与剥脱术+交通静脉结扎术+股浅静脉壁环形缩窄术50例66侧肢体。于手术前1周和手术后1年,采用生活质量调查表评价患者生活质量,内容包括疼痛、体能、社会活动和精神心理4个方面共20个问题。每个问题答案由最轻至最严重5个等级,分别记为1,2,3,4,5分,20题评分之和是总得分,设定100分为理想的生活质量。主要观察指标:手术前后下肢慢性静脉功能不全患者生活质量评分的变化。结果:下肢慢性静脉功能不全患者169例均进入结果分析。①生活质量调查表评分的性别差异:患者手术后1年生活质量调查表总分有明显提高(P<0.05)。术前男女性生活质量调查表总分相近(P>0.05),手术后均有明显提高(P<0.05)。②生活质量调查表评分与术式关系:浅静脉术式组、交通静脉术式组、深静脉术式组术后生活质量调查表总分3组比较,差异无显著性意义(P>0.05)。而在术前深静脉组生活质量调查表总分明显低于浅静脉术式组和交通静脉术式组(P<0.05)。结论:合理的术式可以提高下肢慢性静脉功能不全患者的生活质量,生活质量提高无性别差异。
BACKGROUND： To evaluate the operative efficacy of chronic venous insufficiency （CVI）, we used to emphasize on the improvement of clinical symptom and physical sign without quality of life （QOL）. OBJECTIVE： To assess the QOL in CVI patients before and after operation DESIGN ： Comparative observation, scale evaluation and one-year follow-up SETTING： Department of Vascular Surgery, Renji Hospital, Shanghai Second Medical University PARTICIPANTS： 169 CVI patients （209 lower limbs） including 89 males and 80 females with an average age of （56±13） years and disease course of （11±3） years, who were treated at Department of Vascular Surgery, Renji Hospital, Shanghai Second Medical University from July 2001 to December 2003, were enrolled, All patients knew the therapeutic scheme and evaluation dimensions. METHODS： Three types of operation according to the reflux range and whether deep venous valve imcompetence were carded out. Forty-six subjects with 56 limbs in the superficial venous group received saphenous vein high ligation with stripping the saphenous and varicose vein. Seventy-three subjects with 87 limbs in the perforating venous group underwent both perforating vein ligation and 3aphenous vein high ligabon with stripping the saphenous and varicose vein. Fifty subjects with 66 limbs in the deep venous group received the same operations of group 1 and group 2, in addition to external banding valvuloplasty of the superficial femoral vein, The chronic venous insufficiency questionnaire （CIVIQ） was applied to assess the patients＇ QOL one week before varicose vein surgery and one year later. The main impairment in QOL focused on 4 dimensions （20 questions）, namely pain, physical dimension, social function and psychological dimension. There were five grades to each question （from 1 to 5 points accompany with the serious situation）. Total CIVIQ score was sum score of 20 questions. 100 points indicated ideal QOL. PLAIN OUTCOME MEASURES： CIVIQ scores in CVI patients before and after operation RESULTS ： All 169 CVI patients were involved in the result analysis. ①Sex differences of CIVIQ： The total scores of patients were obviously elevated one year after operation （P 〈 0.05）, There was no significant difference fn CIVIQ scores of both sexes （P 〉 0.05）. The total score was markedly elevated after operation （P 〈 0.05）, ②Relationship between CIVIQ scores and operation type： No significant difference was found in the superficial venous group, the perforating venous group and the deep venous group （P 〉 0.05）, The total CIVIQ scores in the deep venous group before operation were significantly lower than those in the superficial venous group and the perforating venous group （P 〈 0.05）. CONCLUSION： Reasonable operation type can improve the QOL in CVI patients. No significant difference is found in QOL improvement of patients of both sexes.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第36期7299-7301,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
