微切口联合驱血加隧道内压法治疗老年静脉曲张性溃疡疗效分析
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摘要
目的探讨微切口联合驱血加隧道内压法治疗老年静脉曲张性溃疡的疗效。方法选取2016年6月至2017年6月山东省济宁市第一人民医院收治的90例大隐静脉曲张伴下肢溃疡的老年患者,其中45例患者采用微切口联合驱血加隧道内压法术式(观察组),余45例采用单纯微切口术式(对照组),记录两组患者手术时间、术中出血量、术后皮下血肿情况、术后疼痛情况、术后住院时间、门诊随访溃疡愈合情况,并采用静脉临床严重程度评分表(venous clinical severity score, VCSS)进行评分。结果与对照组比较,观察组手术时间明显缩短、术中出血量明显减少、术后血肿发生率明显降低、术后疼痛评分明显降低、住院时间明显缩短、溃疡愈合时间明显缩短(t=18.010、50.320、33.540、19.210、16.680,χ~2=16.250;均P <0.01);两组患者术后随访半年,溃疡均痊愈,未见复发。与治疗前比较,两组患者治疗后VCSS评分均明显降低(t=37.370、49.980,均P <0.01);治疗前两组患者VCSS评分的差异无统计学意义(t=0.000,P> 0.05),治疗后观察组患者VCSS评分显著低于对照组患者(t=14.550,P <0.01)。结论微切口联合驱血加隧道内压法具有手术时间短、出血量小、住院时间短、术后疼痛程度轻、愈合快等优点,而且简单易学、成本低廉,适合在基层医院推广应用。
Objective To observe the efficacy of micro incision combined with exsanguinations band and tunnel pressure on treating senile varicose ulcer.Methods From June,2016 to June,2017,90 senile varicose ulcer patients were included.Forty five patients were treated with micro incision combined with exsanguinations band and tunnel pressure,and another 45 patients were treated with micro incision only.The operation time,intraoperative blood loss,postoperative subcutaneous hematoma,postoperative pain,postoperative hospital stay,and outpatient follow-up ulcer healing were recorded,and graded with venous clinical severity score(VCSS).Results Compared with the control group,the operation time of the observation group was significantly shortened;the amount of intraoperative blood loss was significantly reduced;the incidence of postoperative hematoma was significantly reduced;the postoperative pain score was significantly reduced;the hospitalization time was shortened;and the ulcer healing time was significantly shortened(t=18.010,50.320,33.540,19.210,16.680,χ2=16.250;all P<0.01).Two groups of patients were followed up for half a year.The ulcers were cured with no recurrence.Compared with pre-treatment,the VCSS scores of the two groups were significantly lower after treatment(t=37.370,49.980,P<0.01).There was no significant difference in VCSS score between the two groups before treatment(t=0.000,P>0.05).After treatment,the VCSS score of the observation group was significantly lower than that of the control group(t=14.550,P<0.01).Conclusion Micro-incision combined with exsanguinations band and tunnel pressure treatment has the advantages of short operation time,small amount of bleeding,short hospitalization time,light postoperative pain,quick healing,etc.It is simple and easy to learn,low cost,and suitable for popularization and application in primary hospitals.
Objective To observe the efficacy of micro incision combined with exsanguinations band and tunnel pressure on treating senile varicose ulcer.Methods From June,2016 to June,2017,90 senile varicose ulcer patients were included.Forty five patients were treated with micro incision combined with exsanguinations band and tunnel pressure,and another 45 patients were treated with micro incision only.The operation time,intraoperative blood loss,postoperative subcutaneous hematoma,postoperative pain,postoperative hospital stay,and outpatient follow-up ulcer healing were recorded,and graded with venous clinical severity score(VCSS).Results Compared with the control group,the operation time of the observation group was significantly shortened;the amount of intraoperative blood loss was significantly reduced;the incidence of postoperative hematoma was significantly reduced;the postoperative pain score was significantly reduced;the hospitalization time was shortened;and the ulcer healing time was significantly shortened(t=18.010,50.320,33.540,19.210,16.680,χ2=16.250;all P<0.01).Two groups of patients were followed up for half a year.The ulcers were cured with no recurrence.Compared with pre-treatment,the VCSS scores of the two groups were significantly lower after treatment(t=37.370,49.980,P<0.01).There was no significant difference in VCSS score between the two groups before treatment(t=0.000,P>0.05).After treatment,the VCSS score of the observation group was significantly lower than that of the control group(t=14.550,P<0.01).Conclusion Micro-incision combined with exsanguinations band and tunnel pressure treatment has the advantages of short operation time,small amount of bleeding,short hospitalization time,light postoperative pain,quick healing,etc.It is simple and easy to learn,low cost,and suitable for popularization and application in primary hospitals.
引文
[1]雷勇,赵宁.低分子肝素预防老年大隐静脉曲张术后并发症及复发的效果[J],中国老年学杂志,2017,37(9):2273-2274.
[2]Sarin S,Scurr JH,Coleridge Smith PD.Assessment of stripping the long saphenous vein in the treatment of primary varicose veins[J].Br J Surg,2009,79(9):889-893.
[3]Rutherford RB,Padberg FT Jr,Comerota AJ,et al.Venous severity scoring:An adjunct to the venous outcome assessment[J].Vasc Surg,2000,31(6):1307-1312.
[4]Callam MJ.Epidemiology of varicose veins[J].Br J Surg,1994,81(2):167-173.
[5]Yamany A,Hamdy B.Effect of sequential pneumatic compression therapy on venous blood velocity,refilling time,pain and quality of life in women ith varicose veins:a randomized control study[J].JPhys Ther Sci,2016,28(7):1981-1987.
[6]Wo?niak W,Mlosek RK,Ciostek P.Complications and Failure of Endovenous Laser Ablation and Radiofrequency Ablation Procedures in Patients With Lower Extremity Varicose Veins in a 5-Year FollowUp[J].Vasc ndovascular Surg,2016,50(7):475-483
[7]王慧,李鑫,郭振平.改良手术治疗C5~6级大隐静脉曲张115例结果分析[J].当代医学,2017,23(32):134-135.
[8]Sarin S,Scurr JH,Coleridge Smith PD.Stripping of the long saphenous vein in the treatment of primary varicose veins[J].Br JSurg,1994,81:1455-1458.
[9]Bello M,Scriven M,Hartshorne T,et a1.Role of superficial venous surgery in the treatment of venous ulceration[J].Br J Surg,1999,86(6):755-759.
[10]李孝成,潘光栋.大隐静脉曲张的治疗现状[J].中国血管外科杂志(电子版),2015,7(2):126-128.
[11]徐建军,朱万喜.微小切口点状抽剥联合驱血带在下肢浅静脉曲张抽剥术中的应用[J],中国医学创新,2014,11(28):64-67.
[2]Sarin S,Scurr JH,Coleridge Smith PD.Assessment of stripping the long saphenous vein in the treatment of primary varicose veins[J].Br J Surg,2009,79(9):889-893.
[3]Rutherford RB,Padberg FT Jr,Comerota AJ,et al.Venous severity scoring:An adjunct to the venous outcome assessment[J].Vasc Surg,2000,31(6):1307-1312.
[4]Callam MJ.Epidemiology of varicose veins[J].Br J Surg,1994,81(2):167-173.
[5]Yamany A,Hamdy B.Effect of sequential pneumatic compression therapy on venous blood velocity,refilling time,pain and quality of life in women ith varicose veins:a randomized control study[J].JPhys Ther Sci,2016,28(7):1981-1987.
[6]Wo?niak W,Mlosek RK,Ciostek P.Complications and Failure of Endovenous Laser Ablation and Radiofrequency Ablation Procedures in Patients With Lower Extremity Varicose Veins in a 5-Year FollowUp[J].Vasc ndovascular Surg,2016,50(7):475-483
[7]王慧,李鑫,郭振平.改良手术治疗C5~6级大隐静脉曲张115例结果分析[J].当代医学,2017,23(32):134-135.
[8]Sarin S,Scurr JH,Coleridge Smith PD.Stripping of the long saphenous vein in the treatment of primary varicose veins[J].Br JSurg,1994,81:1455-1458.
[9]Bello M,Scriven M,Hartshorne T,et a1.Role of superficial venous surgery in the treatment of venous ulceration[J].Br J Surg,1999,86(6):755-759.
[10]李孝成,潘光栋.大隐静脉曲张的治疗现状[J].中国血管外科杂志(电子版),2015,7(2):126-128.
[11]徐建军,朱万喜.微小切口点状抽剥联合驱血带在下肢浅静脉曲张抽剥术中的应用[J],中国医学创新,2014,11(28):64-67.