摘要
目的探讨点状切口交通支静脉结扎术治疗下肢慢性静脉性溃疡的疗效。方法采用回顾性病例对照研究。观察组为我科从2022年6月至2023年6月收治的25例下肢慢性静脉性溃疡病例,采用大隐静脉高位结扎+分段剥脱术+点状切口交通支静脉结扎术治疗。对照组为我科2013年12月至2022年12月收治的25例下肢慢性静脉性溃疡病例,采用大隐静脉高位结扎+分段剥脱术+腔镜深筋膜下交通静脉离断术(subfascial endoscopic perforator vein surgery,SEPS)治疗。比较两组患者的临床疗效及围术期指标。结果术后2周内溃疡愈合率比较,观察组高于对照组,为88%(22/25)vs.40%(10/25)(P<0.001);并发症发生率比较无统计学差异,为0 vs.4%(1/25)(P>0.05)。两组术后1年内均无复发病例,对照组术后5年有1例复发,原因为下肢深静脉瓣膜功能不全由Ⅱ°进展到Ⅳ°,非交通支静脉功能不全引起,复发病例再次实施股总静脉人工血管戴戒术后治愈。观察组平均手术时间(60.5±7.4)min,平均出血量(20.0±3.6)mL,术后平均住院天数(16.0±1.2)d,住院费用为(1.2±0.2)万元,结扎交通支(2±1)条;对照组平均手术时间(120.3±8.5)min,平均出血量(50.6±4.5)mL,术后平均住院天数(20.0±1.4)d,住院费用(2.0±0.2)万元,结扎交通支(2±1)条。与对照组比较,观察组手术时间更短,出血量更少,住院天数更短,住院费用更低(P<0.05),而两组结扎交通支数量和术后1年的溃疡复发率比较无统计学差异(P>0.05)。结论点状切口小腿交通支静脉结扎术治疗下肢慢性静脉性溃疡是安全、有效、可行的手术方式,且操作简单,费用较低,对器械和设备的要求不高,更适合在基层医院推广。
Objective To explore the efficacy of mini-incision ligation of the perforator veins for the treatment of chronic venous ulcers in lower limbs.Methods A retrospective case-control study was used.The observation group consisted of 25 cases of chronic venous ulcers in the lower limbs admitted to our department from June 2022 to June 2023.They were treated with high ligation of the great saphenous vein,segmented extraction,and mini-incision ligation of the perforator veins.The control group consisted of 25 cases of chronic venous ulcers in the lower limbs admitted to our department from December 2013 to December 2022.They were treated with high ligation of the great saphenous vein,segmental extraction,and subfascial endoscopic perforator vein surgery(SEPS).It was compared of the clinical efficacy and perioperative indicators between two groups.Results The postoperative 2-week ulcer healing rate was higher in the observation group than in the control group,which was 88%(22/25)vs.40%(10/25)(P<0.001).There was no significant difference in the complication rate,which was 0 vs.4%(1/25)(P>0.05).There was no postoperative 1-year recurrence,except 1 case in the control group relapsed 5 years after surgery,which caused by the progression of lower limb deep vein valve dysfunction fromⅡ°toⅣ°.The observation group had an average surgical time of(60.5±7.4)minutes,an average blood loss of(20.0±3.6)mL,an average postoperative hospital stay of(16.0±1.2)days,an average hospitalization cost of(1.2±0.2)ten thousand yuan,and the number of ligatured perforator veins of 2±1;while in the control group,it was(120.3±8.5)minutes,(50.6±4.5)mL,(20.0±1.4)days,(2.0±0.2)ten thousand yuan,and 2±1,respectively.Compared with the control group,the observation group had shorter surgical time,less bleeding,shorter hospital stay,and less hospitalization cost(P<0.05).But there was no difference in the number of ligatured perforator veins and ulcer recurrence rates between the two groups(P>0.05).Conclusion Mini-incision ligation of the perforator veins is a safe,effective,and feasible surgical method for treating chronic venous ulcers in lower limbs.It is simple to operate,cost-effective,with low requirement of equipment and instruments,making it more suitable for promotion in primary hospitals.
作者
许玉春
李轶辉
杨彬
余张涛
李虎
XU Yuchun;LI Yihui;YANG Bin;YU Zhangtao;LI Hu(Department of General Surgery,the 921st Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Changsha 410003,Hunan,China)
出处
《中国现代手术学杂志》
2024年第3期218-222,共5页
Chinese Journal of Modern Operative Surgery
基金
2022年度湖南省教育厅科学研究项目(22C0039)。
