高位结扎剥脱联合透光旋切与高位结扎联合腔内激光治疗大隐静脉曲张的对比分析
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摘要
目的分析高位结扎剥脱联合TriVex~(TM)透光旋切(TIPP)与高位结扎联合腔内激光(EVLT)治疗大隐静脉曲张的临床效果。方法大隐静脉曲张病人238例,随机分成TIPP和EVLT组,每组各119例。TIPP组对大隐静脉主干进行高位结扎、剥脱后各曲张属支以透光旋切的方法去除,EVLT组对大隐静脉主干进行高位结扎后主干及各曲张属支以激光灼闭的方法处理;比较两组病人术后恢复情况及并发症发生情况。结果两组病人手术时间、术后症状改善率比较差异无统计学意义(P>0.05),TIPP组隐神经损伤、皮肤损伤发生率少于EVLT组(P<0.05),TIPP组手术切口数量、术中出血量、皮下血肿发生率均高于EVLT组(P<0.05)。结论 TriVex~(TM)透光旋切治疗与高位结扎联合腔内激光治疗大隐静脉曲张各有优点,EVLT手术切口少、术中出血少,更适合于轻症病人;TIPP对于重症病人具有手术创伤小的优点。
Objective To investigate the efficacy of transilluminated powered phlebectomy( TIPP) and endovanous laser treatment( EVLT) combined with high ligation on treating varicose great saphenous vein. Methods A total of 238 cases with varicose great saphenous vein were divided into TIPP group( 119 cases) and EVLT group( 119 cases). The incidence of postoperative recovery and complications of the two groups were compared. Results There was no significant difference between the two groups on the surgery duration and postoperative recovery incident( P > 0. 05); the saphenous nerve injury incidence and skin impairment incidence of the TIPP group were significantly less than that of EVLT group( P <0. 05); the amount of bleeding,subcutaneous hematoma incidence,and amount of surgical incision of TIPP group were significantly more than that of the EVLT group( P < 0. 05). Conclusions TIPP and EVLT combined with high ligation are two effective minimally invasive surgical approaches on treating varicose great saphenous vein. EVLT is with less surgical incision and less bleeding,and is more applicable for mild case; TIPP is with less operative trauma,and is more applicable for severe case.
Objective To investigate the efficacy of transilluminated powered phlebectomy( TIPP) and endovanous laser treatment( EVLT) combined with high ligation on treating varicose great saphenous vein. Methods A total of 238 cases with varicose great saphenous vein were divided into TIPP group( 119 cases) and EVLT group( 119 cases). The incidence of postoperative recovery and complications of the two groups were compared. Results There was no significant difference between the two groups on the surgery duration and postoperative recovery incident( P > 0. 05); the saphenous nerve injury incidence and skin impairment incidence of the TIPP group were significantly less than that of EVLT group( P <0. 05); the amount of bleeding,subcutaneous hematoma incidence,and amount of surgical incision of TIPP group were significantly more than that of the EVLT group( P < 0. 05). Conclusions TIPP and EVLT combined with high ligation are two effective minimally invasive surgical approaches on treating varicose great saphenous vein. EVLT is with less surgical incision and less bleeding,and is more applicable for mild case; TIPP is with less operative trauma,and is more applicable for severe case.
引文
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[9]刘岩,沈根海,高泉根,等.腔内激光闭合结合高位结扎术治疗大隐静脉曲张临床分析[J].临床外科杂志,2013,21(9):728-729.
[10]林松斌,王烈.下肢静脉曲张微创手术的进展[J].临床外科杂志,2012,20(9):895-897.
[2]张培华,蒋米而,戴天乐,等.华东四省一市周围血管疾病调查研究[J].普外临床,1993,3(8):162.
[3]Hirai M,Iwata H,Sawazaki N.Comparison of recurrence rate and hemodynamic effect among various technical approaches for ligations of great saphenous vein in treatment of varicose veins[J].Vasa,2007,36(1):23-27.
[4]Aremu MA,Mahendran B,Butcher W,et al.Prospective randomized controlled trial:conventional versus powered phlebectomy[J].J Vasc Surg,2004,39(1):88-94.
[5]Cheshire N,Elias SM,Keagy B,et al.Powered plebectomy(Tri Vex)in treatment of varicose veins[J].Ann Vasc Surg,2002,16(4):488-494.
[6]Proebstle TM,Lehr HA,Karql A,et al.Endovenous treatment of the greater saphenous vein with a 940-nm diode laser:Thrombotic occlusion after endoluminl thermal damage by laser-generated steam bubbles[J].J Vasc Surg,2002,35(4):729-736.
[7]Corcos L,Dini S,De Anna D,et al.The immediate effects of endovenous diode 808-nm laser in greater saphenous vein:morphologic study and clinical implications[J].J Vasc Surg,2005,41(6):1081-1024.
[8]Proebstle TM,Gul D,Lehr HA,et al.Infrequent early recanalization of greater saphenous vein after endovenous laser treatment[J].Vasc Surg,2003,38(3):511-516.
[9]刘岩,沈根海,高泉根,等.腔内激光闭合结合高位结扎术治疗大隐静脉曲张临床分析[J].临床外科杂志,2013,21(9):728-729.
[10]林松斌,王烈.下肢静脉曲张微创手术的进展[J].临床外科杂志,2012,20(9):895-897.