腔内激光联合高位结扎治疗原发性下肢静脉曲张术后抗凝与否的随机对照研究

目的探讨下肢静脉腔内激光治疗（Endovenous Laser Treatment，EVLT）联合大隐静脉（Great Saphenous Vein，GSV）高位结扎治疗原发性下肢静脉曲张术后是否需要抗凝治疗。方法本实验设计为前瞻性的随机对照临床研究，将原发性下肢静脉曲张患者189例，随机分为对照组（A组），患者96例；抗凝组（B组），患者93例。两组患者均进行静脉腔内激光治疗及大隐静脉高位结扎术，B组患者术后给予皮下注射低分子肝素，A组术后不给予低分子肝素，其它处理相同。观察两组患者术后3d、2周和3个月术肢有无深静脉血栓形成。所有患者随访时间3个月。结果189例原发性下肢静脉曲张患者，在术后随访期间，仅A组有1例发生术肢深静脉血栓形成（Deep Vein Thrombosis，DVT）；其余无一例发生DVT和肺栓塞。A、B两组间术后下肢深静脉血栓形成发病率无显著性意义（P〉0．05）。结论腔内激光联合高位结扎治疗原发性下肢静脉曲张术后是否应用抗凝药物对预防下肢深静脉血栓形成没有显著性影响，术后不需要常规应用抗凝药物。

Randomized Clinical Trial on Anticoagulation after Endovenous Laser Treatment Combined with High Ligation of Primary Great Saphenous Varicose Veins

Objective To study whether anticoagulation is a must after EVLT （endovenous laser treatment） combined with high ligation for patients of primary great saphenous varicose veins. Methods Consecutive consenting patients with symptomatic varicose veins were divided randomly into group A （ not given LMWH）and group B （ given LMWH after EVLT）. Principal outcomes were evaluated with duplex ultrasound to determine DVT at various time points till at least 3 months after the operation. Results Altogether 189 patients with primary great saphenous varicose veins were treated with EVLT in combination with high ligation. While 93 patients （ group B） were given LMWH after EVLT, ＇the rest 96 patients （ group A） were not given LMWH. During the 3 months＇follow-up after the EVLT, no significant difference was found between the two groups （P 〉0. 05）. Only in one case was DVT found in the lower extremity treated, and no pulmonary embolism was found in both groups. Conclusions Our prospective study shows it is not significantly different whether anticoagulation was applied to patients of primary great saphenous varicose veins after the combined treatment of EVLT and high ligation within 3 months＇follow-up. There is no need to apply routine anticoagulation to patients of primary great saphenous varicose veins after the combined treatment of EVLT and high ligation.