邵立军 陈年进 卢朝德

[摘要] 目的 比较高位结扎+腔内激光治疗+局部剥脱术与传统手术治疗中重度大隐静脉曲张的疗效。 方法 回顾性分析2013年7月～2015年11月我院收治的64例中重度大隐静脉曲张患者，将其相对随机分为A、B两组。A组32例行传统高位结扎+剥脱术；B组32例行高位结扎+腔内激光治疗+局部剥脱术。观察比较两组患者的手术时间、术后下床时间、术后住院时间、切口数量、术后疼痛评分、术后并发症。 结果 B组患者手术时间、术后下床时间、术后住院时间短于A组，切口数量少于A组，术后疼痛评分均低于A组，两组比较差异有统计学意义（P<0.05）。B组术后并发症发生率（6.2%）明显低于A组（25.0%）。 结论 大隐静脉高位结扎+腔内激光治疗+局部剥脱术治疗中重度大隐静脉曲张较传统手术有优势。

[关键词] 大隐静脉曲张；激光腔内治疗；对比研究

[中图分类号] R654.3 [文献标识码] A [文章编号] 1674-4721（2016）03（c）-0042-03

[Abstract] Objective To compare the effect in the treatment of medium and severe varicosis of great saphenous vein with high ligation+cavity laser therapy+local stripping and the conventional surgeries. Methods 64 patients with medium and severe varicosis of great saphenous vein who were admitted in our hospital from July 2013 to November 2015 were retrospectively analyzed and assigned randomly into group A and group B.Patients in group A were conducted conventional surgeries of high ligation and stripping while patients in group B were received surgeries of high ligation+cavity laser therapy+local stripping.The postoperative off-bed time，hospitalization time，incision number，postoperative pain grades and complications of the patients between the two groups were observed and compared. Results Patients in group B had shorter off-bed time and hospitalization time，less incision number，lower postoperative pain grades than patients in group A.The differences had statistical significance（P<0.05）.The occurrence of postoperative complication of group B was 6.2%，significantly lower than 25.0% of group A. Conclusion For patients with medium and severe varicosis of great saphenous vein，the high ligation+cavity laser therapy+local stripping had advantages compared with the conventional surgeries.

[Key words] Varicosis of great saphenous vein；Cavity laser therapy；Comparative study

大隐静脉曲张的外科传统手术治疗方法为高位结扎+抽剥术，但该手术创伤较大，恢复较慢，体表瘢痕明显。1997年美国血管外科医师Robert首先应用激光治疗该病，取得了良好的临床效果[1]。国内2003年开始应用此法治疗轻中度的大隐静脉曲张，同样取得了良好效果[2]，但单纯激光治疗对于重度大隐静脉曲张效果欠佳。我科于2013年7月引进DIOMED激光治疗仪，对于中重度大隐静脉曲张开始实施大隐静脉高位结扎+激光腔内治疗+局部剥脱术，取得较好的效果，现与同期实施的传统手术比较，报道如下。

1 资料与方法

1.1 一般资料

选取2013年7月～2015年11月我院收治的单侧中重度原发性大隐静脉曲张患者64例，男性44例，女性20例，年龄36～78岁，平均56岁，伴有患肢皮肤色素沉着22例，皮肤营养改变者14例，经多普勒超声或下肢CTV明确不伴有深静脉血栓形成及下肢深静脉瓣膜功能不全。……