3种微创手术方法治疗大隐静脉曲张的临床对比分析

A comparative analysis of three different minimally invasive surgical approaches for treatment of great saphenous vein varicosity

摘要:

目的：对比分析3种不同微创手术方式治疗大隐静脉曲张（Great saphenous vein varicosity，GSVV）的疗效。方法：回顾分析2008年1月至2011年1月收治的248例GSVV病例，分别采用新型微创剥脱器（New minimally invasive stripper，NMIS），血管腔内激光闭合（Endovenous laser ablation，EVLA），透光旋切（Transilluminated powered phlebectomy，TIPP）治疗；其中NMIS组共103例，EVLA组共 87例，TIPP组共58例。比较3组住院费用、术中出血量、术后住院时间、手术时间、术后并发症的发生率及溃疡皮肤干燥及愈合情况。结果：NMIS组住院费用较EVLA组和TIPP组显著降低（P<0.01）。EVLA组平均术中出血量最少，TIPP组最多（P<0.01）。EVLA组术后住院时间较NMIS组和TIPP组显著缩短（P<0.01）。TIPP组术后溃疡皮肤干燥及愈合时间较NMIS组显著缩短（P<0.01），且无溃疡未愈患者。3组术后并发症差异无统计学意义（P>0.01）。3组手术时间差异无统计学意义（P＞0.01）。结论：采用新型微创剥脱器和血管腔内激光闭合治疗ＧＳＶＶ临床效果及术后并发症相当，前者有较明显的经济优势，后者有较明显的美容及时间优势；TIPP适合治疗伴有皮肤溃疡的GSVV。

Abstract:

Objective：To comparatively analysis the treatment effects of three minimally invasive surgical approaches for great saphenous vein varicosity（GSVV）. Methods：To retrospective analysis 248 cases GSVV from January 2008 to January 2011. All samples were respectively treated by new minimally invasive stripper（NMIS，103 cases），endovenous laser ablation （EVLA，87 cases） or transilluminated powered phlebectomy （TIPP，58 cases）；It was compared each group that the hospitalization fee、amount of bleeding、mean length of hospital stay、time of surgery、postoperative complications and skin ulcers drying and healing time. Results：NMIS group mean hospitalization fee was least in three groups（P<0.01），Amount of bleeding was least in EVLA group and most in TIPP group（P<0.01）. Mean length of hospital stay in EVLA group was notable shorter than that in NMIS and TIPP groups（P<0.01）. The skin ulcers drying and healing time in TIPP groups was shorter than that in NMIS group（P<0.01），and all skin ulcers was cured in TIPP groups.Postoperative complication rate and the time of surgery were similar in three groups（P>0.01）. Conclusion：The therapeutic effect of surgery for GSVV with NMIS was as good as surgery with EVLA，and the complication rate was similar.The former has obviously economic advantage，the latter has obviously cosmetic and time advantage. TIPP has obviously therapeutic advantage for GSVV patients with skin ulcers.