史卫军++++++田众一

[摘要] 目的 比较泡沫硬化疗法联合中药外洗法与传统外科手术治疗下肢静脉曲张伴静脉溃疡的效果。 方法 收集2011年1月～2015年12月于上海市浦东医院普外科住院治疗的下肢静脉曲张伴静脉溃疡患者共160例，根据治疗方式分为传统手术组55例和硬化联合外洗组105例。传统手术组采用大隐静脉高位结扎、剥脱以及点状抽剥术，硬化联合外洗组则采用泡沫硬化治疗、大隐静脉高位结扎术、腔内激光闭塞术，术后同时采用中药外洗法。观察两组患者手术时间、住院治疗费用、术后住院总时间、术后疼痛、手术切口数量、主观感受好转程度、术后并发症以及溃疡表面面积。 结果 硬化联合外洗组在手术时间、住院治疗费用、术后住院时间、术后疼痛、手术切口数量、主观感受好转程度、术后并发症以及溃疡表面面积方面明显优于传统手术组（P < 0.05）。 结论 与传统手术治疗相比，泡沫硬化疗法联合中药外洗法，同时采用大隐静脉主干高位结扎术与腔内激光闭塞治疗下肢静脉曲张伴静脉溃疡具有安全、可靠、简单、经济、可重复的特点，将成为一项具有明显特色的治疗技术。

[关键词] 下肢静脉曲张；泡沬硬化疗法；中药外洗法；传统手术治疗；腔内激光

[中图分类号] R654.4 [文献标识码] A [文章编号] 1674-4721（2016）09（a）-0064-04

[Abstract] Objective To compare the clinical effect of foam sclerotherapy combined Chinese herb wash and traditional srugery in the treatment of varicose veins of lower extremity combined with venous ulcer. Methods 160 cases of patients with varicose veins of lower extremity combined with venous ulcer treated in Department of General Surgery， Shanghai Pudong Hospital from January 2011 to December 2015 were seleeted. According to the treatmemt method， patients were divided into the traditional surgery group （n=55） and the sclerotherapy combined washing group （n=105）. Patients in the traditional surgery group were given saphenous vein ligation exfoliation and point stripping surgery. Patinets in the sclerotherapy combined washing group were given foam sclerotherapy treatment， saphenous vein ligation exfoliation， intracavity laser occlusion and Chinese herb wash after surgery. The outcomes were analyzed， including operative time， hospitalization cost， hospital stay time， postoperative pain， surgical incision number， subjective feelings improvement， postoperative complications and ulcer surface area. Results The outcomes including operative time， hospitalization cost， hospital stay time， postoperative pain， surgical incision number， subjective feelings improvement， postoperative complications and ulcer surface area in the sclerotherapy combined washing group were better than those in the traditional surgery group， with statistically significant differences （P < 0.05）.Conclusion Compared with the traditional surgery， foam sclerotherapy combined Chinese herb wash， meanwhile by using of saphenous vein ligation exfoliation and intracavity laser occlusion in the treatment of varicose veins of lower extremity combined with venous ulcer is a safe， reliable， simple， economical and repeatable treatment method， which will become a characteristic treatment technology.

[Key words] Varicose veins of lower extremity； Foam sclerotherapy； Chinese herb wash； Traditional surgery treatment； Endovenous laser

下肢静脉曲张是血管外科的常见病以及多发病[1]，目前我国发病率为10%[2]。严重的下肢静脉曲张容易同时并发小腿溃疡，下肢静脉曲张伴静脉溃疡经久不愈，治疗比较困难，一直是困扰临床的难题[3]。近年来，由于泡沫硬化疗法操作简单、疗效明显等优势，临床医生日益关注其对下肢静脉曲张的治疗。泡沫硬化疗法对于未发生溃疡的下肢静脉曲张的治疗效果已经较为肯定，但是针对伴静脉溃疡的下肢静脉曲张治疗尚未达成共识[4]。……