静脉腔内激光和传统手术治疗静脉性溃疡的疗效比较研究(1)
[摘要] 目的 探討下肢静脉性溃疡静脉腔内激光治疗与传统静脉剥离术治疗的临床疗效差异。 方法 选择2014年12月～2015年12月我院收治的97例下肢静脉性溃疡患者作为研究对象，按照临床选择手术方案的不同，分为两组，对照组：开展传统手术治疗，47例；观察组：开展静脉腔内激光治疗，50例。其中，传统静脉剥离手术治疗遵循高位结扎、切除曲张浅静脉、局部处理的方案。比较两组患者手术相关指标差异、术后并发症以及术后常规随访情况，综合评价两种手术方式的临床应用效果，通过对术后1周内以及6个月时间的随访中，患者静脉血栓、皮下硬结、局部溃疡糜烂、疼痛、色素沉着、下肢肿胀情况进行判定，综合评价手术远期疗效。 结果 观察组患者手术时间、术中出血量、手术切口长度较对照组有统计学意义(P<0.05)。观察组术后加压绷带使用时间较对照组差异无统计学意义(P>0.05)。观察组平均住院时间较对照组有明显差异(P<0.05)。术后1 d 观察组患者VAS评分显著低于对照组。观察组术后3例患者发生局部复张，无静脉血栓形成，与对照组患者比较，差异无统计学意义(P>0.05)。术后并发症皮下血肿、切口愈合不良、局部皮肤感觉障碍方面，对照组与观察组发生率差异显著(P<0.05)，观察组术后并发症发生率显著低于对照组。术后近期与随访远期疗效方面，观察组与对照组差异无统计学意义。 结论 静脉腔内激光疗法对静脉性溃疡患者手术疗效与传统开放性手术具有一致性，但疗效显著的同时可以最大程度地减少术后并发症以及手术带来的危险与疼痛，具有显著的安全性与舒适性，值得临床推广。
[关键词] 静脉腔内激光；传统手术；静脉剥离；静脉性溃疡；安全性
[中图分类号] R285.5 [文献标识码] B [文章编号] 1673-9701(2016)36-0059-04
[Abstract] Objective To investigate the difference in clinical efficacy between intravenous luminal laser and traditional venous removal in the treatment of lower extremity venous ulcers. Methods 97 patients with lower extremity venous ulcer who were treated in our hospital from December 2014 to December 2015 were chosen and divided into two groups，including the control group with 47 cases of traditional surgical treatment and observation group with 50 cases of intravenous laser treatment，according to the different clinical options.Among them， the traditional vein removal surgery followed the program of high ligation， removal of varicose veins and local treatment. Surgical conditions，differences of surgical-related indicators， postoperative complications and routine follow-up between the two groups were compared.Clinical application effect of the two surgical methods were comprehensively evaluated.Long-term efficacy of surgery were comprehensively evaluated by determining venous thrombosis，subcutaneous induration，local ulcer erosion，pain， pigmentation and lower extremity swelling in the 1w and 6 months of postoperative follow-up. Results There were significant differences in the operation time， intraoperative blood loss and operation incision length between the observation group and the control group(P<0.05). There was no significant difference in the time of postoperative pressure bandage between the observation group and the control group (P>0.05). The average hospitalization in the observation group was significantly different from that in the control group(P<0.05). The VAS score of the observation group was significantly lower than that of the control group on 1 day after operation.3 patients in the observation group had local tension and no venous thrombosis，and there was no difference compared with the control group(P>0.05). The incidence of postoperative complications including subcutaneous hematoma， incisional healing and local skin sensory disturbance were significantly different between the control group and the observation group(P<0.05). The number of postoperative complications in the observation group was significantly lower than that in the control group. There was no statistically significant difference between the observation group and the control group in terms of efficacy in long-term follow-up and recent follow-up，and the two groups were consistent. Conclusion There is consistency in the efficacy between intravenous laser radiation therapy and traditional open surgery for patients with venous ulcer. And intravenous laser radiation therapy can also minimize the postoperative complications and the risks and pain brought by surgery， with significant safety and comfort， which is worthy of clinical promotion. (王琛 孙和平 徐小盛)
[关键词] 静脉腔内激光；传统手术；静脉剥离；静脉性溃疡；安全性
[中图分类号] R285.5 [文献标识码] B [文章编号] 1673-9701(2016)36-0059-04
[Abstract] Objective To investigate the difference in clinical efficacy between intravenous luminal laser and traditional venous removal in the treatment of lower extremity venous ulcers. Methods 97 patients with lower extremity venous ulcer who were treated in our hospital from December 2014 to December 2015 were chosen and divided into two groups，including the control group with 47 cases of traditional surgical treatment and observation group with 50 cases of intravenous laser treatment，according to the different clinical options.Among them， the traditional vein removal surgery followed the program of high ligation， removal of varicose veins and local treatment. Surgical conditions，differences of surgical-related indicators， postoperative complications and routine follow-up between the two groups were compared.Clinical application effect of the two surgical methods were comprehensively evaluated.Long-term efficacy of surgery were comprehensively evaluated by determining venous thrombosis，subcutaneous induration，local ulcer erosion，pain， pigmentation and lower extremity swelling in the 1w and 6 months of postoperative follow-up. Results There were significant differences in the operation time， intraoperative blood loss and operation incision length between the observation group and the control group(P<0.05). There was no significant difference in the time of postoperative pressure bandage between the observation group and the control group (P>0.05). The average hospitalization in the observation group was significantly different from that in the control group(P<0.05). The VAS score of the observation group was significantly lower than that of the control group on 1 day after operation.3 patients in the observation group had local tension and no venous thrombosis，and there was no difference compared with the control group(P>0.05). The incidence of postoperative complications including subcutaneous hematoma， incisional healing and local skin sensory disturbance were significantly different between the control group and the observation group(P<0.05). The number of postoperative complications in the observation group was significantly lower than that in the control group. There was no statistically significant difference between the observation group and the control group in terms of efficacy in long-term follow-up and recent follow-up，and the two groups were consistent. Conclusion There is consistency in the efficacy between intravenous laser radiation therapy and traditional open surgery for patients with venous ulcer. And intravenous laser radiation therapy can also minimize the postoperative complications and the risks and pain brought by surgery， with significant safety and comfort， which is worthy of clinical promotion. (王琛 孙和平 徐小盛)