腔镜深筋膜下交通支静脉离断术联合激光闭合术治疗大隐静脉曲张的疗效

背景与目的 手术为治疗大隐静脉曲张（GSV）有效措施，传统交通支静脉结扎术虽疗效肯定，但创伤较大，并发症多，且术后复发率高，增加二次治疗风险。腔镜深筋膜下交通支静脉离断术（SEPS）、激光闭合术（EVLT）为新型的治疗手术，各具优势，本研究探讨EVLT与SEPS联合治疗GSV的临床效果，以期为临床治疗选择提供参考。方法 选取2018年6月—2019年10月承德医学院附属医院收治的78例GSV患者，依据简单随机数字表法分为研究组与对照组，各39例。研究组采取SEPS+EVLT，对照组采取传统交通支静脉结扎术+EVLT。比较两组手术情况、创伤定量指标水平、生活质量、并发症发生率以及疾病复发率。结果 术前两组间一般资料、术前创伤定量指标与生活质量评分差异均无统计学意义（均P>0.05）。研究组手术时间、住院时间短于对照组，术中失血量、住院费用少于对照组，下肢瘀斑面积、切口长度小于对照组（均P<0.05）；研究组术后24、72 h血清丙二醛、一氧化氮、IL-6水平均低于对照组，谷胱甘肽过氧化物酶水平高于对照组（均P<0.05）。术后1周研究组精神心理、体能、社会活动、疼痛评分均优于对照组（均P<0.05）；研究组并发症发生率低于对照组（2.56% vs. 20.51%，P<0.05）；研究组术后12个月疾病复发率低于对照组（5.56% vs. 26.47%，P<0.05）。结论 SEPS联合EVLT治疗GSV，具有创伤小、手术时间短、术后恢复快、并发症少、住院费用低、提高生活质量等优势，推荐临床使用。

Efficacy of subfascial endoscopic perforator surgery combined with endovenous laser closure in the treatment of great saphenous vein varices

Background and Aims Surgery is an effective treatment for great saphenous varicose veins (GSV). However, although traditional perforating vein ligation has demonstrable efficacy, it has many disadvantages, such as relatively large trauma, frequent postoperative complications, and a high postoperative recurrence rate, which increase the risk of secondary treatment. Subfascial endoscopic perforator surgery (SEPS) and endovenous laser treatment (EVLT) are new therapeutic procedures, and each has its advantages. Therefore, this study was performed to investigate the clinical efficacy of EVLT combined with SEPS for the treatment of GSV to provide clinical treatment options.Methods Seventy-eight patients with GSV admitted to Department of Vascular Surgery, Affiliated Hospital of Chengde Medical College from June 2018 to October 2019 were selected and assigned to study group and control group, with 39 cases in each group, using random number table method. Patients in study group underwent SEPS plus EVLT, and those in control group were subjected to conventional perforating vein ligation plus EVLT. The surgical variables, oxidative stress markers, scores for quality of life, incidence of complications and disease recurrence rate were compared between the two groups.Results There were no significant differences in the general data, preoperative levels of oxidative stress markers, and scores for quality of life between the two groups (all P>0.05). The operative time and length of hospital stay were shorter, the intraoperative blood loss and hospitalization costs were less, and the area of petechiae and length of incision on the lower limbs were smaller in study group than those in control group (all P<0.05); the serum levels of malondialdehyde, NO and IL-6 were lower, while glutathione peroxidase was higher at 24 and 72 h after surgery in study group than those in control group (all P<0.05). The scores for psychophysiological state, physical performance, social activity, and pain in study group were superior to those in control group one week after surgery (all P<0.05). The incidence of complications in study group was lower than that in control group (2.56% vs. 20.51%, P<0.05), and the disease recurrence rate on 12 months after surgery in study group was lower than that in the control group (5.56% vs. 26.47%, P<0.05).Conclusion SEPS combined with EVLT for the treatment of GSV has the advantages of less trauma, shorter operative time, faster postoperative recovery, fewer complications, and lower hospitalization costs, as well as improving the patient''s quality of life. So, it is recommended to be used in clinical practice.