下肢慢性静脉功能不全伴脂质硬皮症的手术治疗

目的：探讨手术治疗下肢慢性静脉功能不全（chronic venous insufficiency,CVI）伴脂质硬皮症（lipodermatosclerosis,LDS）的疗效。方法：对36例CVI伴LDS患者行大、小隐静脉高位结扎术联合点式浅静脉分段抽剥术和交通静脉结扎术。采用临床严重程度评分（venous clinical severity score,VCSS）、生活质量量表（chronic venous insufficiency questionnaire,CIVIQ）对其进行术前评估和术后随访,并测量LDS皮下硬结厚度。采用配对t检验比较患者手术前后VCSS、CIVIQ评分和LDS皮下硬结厚度。结果：36例患者均得到随访,随访率100%;随访期为6~12个月,平均8.2个月。36例患者术后CEAP分级均明显改善;VCSS评分均值术前为8.14分,术后为0.56分,手术前后差异有统计学意义（P〈0.01）;CIVIQ评分均值术前为84.0分,术后为98.2分,手术前后差异有统计学意义（P〈0.01）;LDS皮下硬结厚度均值术前为1.27 cm,术后为0.03 cm,手术前后差异有统计学意义（P〈0.01）。结论：采用大、小隐静脉高位结扎术联合点式浅静脉分段抽剥术和交通静脉结扎术治疗CVI伴LDS的患者,可明显改善LDS,促进溃疡愈合,提高患者的生活质量。

Efficacy of Surgery Treatment in Chronic Venous Insufficiency with Lipodermatosclerosis

Objective：To investigate the efficacy of surgery treatment in patients with lipodermatosclerosis（LDS）induced by chronic venous insufficiency（CVI）.Methods：A total of 36 patients with LDS induced by CVI were treated with ligation of great saphenous veins or small saphenous veins in a high level combined with stripping and/or ligation of perforating veins and point mode drainage surgery at sites of LDS.Venous clinical severity score（VCSS）,chronic venous insufficiency questionnaire（CIVIQ）and thickness of skin with LDS were evaluated before and after surgery.Paired sample t test was used to compare the parameters before and after surgery.Results：All the 36（100%）patients have been followed up for 6 to 12 months（average,8.2 months）.CEAP levels were improved obviously in all the 36 patients.Mean value of VCSS went down to 0.56 post-operation from preoperative 8.14,and the difference between the two groups was statistically significant（P〈0.01）.Mean value of CIVIQ score went up to 98.2 post-operation from preoperative 84 and the difference between the two groups was statistically significant（P〈0.01）.Mean value of the thickness of skin with LDS went down to 0.03 cm post-operation from preoperative 1.27 cm and the difference between the two groups was statistically significant（P〈0.01）.Conclusions：The curative effect was satisfactory to treat patients with LDS induced by CVI by ligation of great saphenous veins or small saphenous veins in a high level combined with stripping and/or ligation of perforating veins and point mode drainage surgery at sites of LDS.After operation,LDS,ulcer as well as the life quality of the patients can be improved.