腔内激光与腔内激光联合泡沫硬化剂治疗下肢静脉曲张的比较研究

目的探讨腔内激光联合泡沫硬化剂治疗下肢静脉曲张的疗效和安全性。方法 2010年7月～2011年10月将120例下肢静脉曲张按就诊顺序编号,每10例为一分配单元,1～10号为单纯激光组,11～20号为联合治疗组,以此类推,每组60例。单纯激光组:大隐静脉高位结扎后,用980 nm波长半导体激光腔内治疗大隐静脉主干、大隐静脉属支及曲张的静脉团;联合治疗组:大隐静脉高位结扎后,用980 nm波长半导体激光腔内激光治疗大隐静脉主干,泡沫硬化剂5 ml(1 ml聚桂醇注射液及4 ml空气经三通器混合制成5 ml泡沫硬化剂,现用现配)静脉注射治疗属支静脉及静脉团。结果所有患者随访6～12个月,平均9个月。单纯激光组痊愈56例,显效4例,总有效率100%;联合治疗组痊愈58例,显效2例,总有效率100%,2组疗效比较差异无显著性(Z=-0.834,P=0.404)。2组术后复发率无统计学差异6.7%(4/60)vs.3.3%(2/60),χ2=0.175,P=0.675]。腔内激光组并发症发生率为35.0%(21/60),联合治疗组并发症发生率为3.3%(2/60),2组比较差异有显著性(χ2=19.417,P=0.000)。结论与单纯腔内激光治疗比较,腔内激光联合泡沫硬化剂治疗下肢静脉曲张并发症少,疗效无差别。

Comparison between Endovenous Laser Treatment(EVLT) and EVLT Combined with Foam Sclerotherapy for Varicose Veins of the Lower Limbs

Objective To evaluate the efficacy and safety of endovenous laser treatment(EVLT) combined with foam sclerotherapy for varicose veins of the lower limbs.Methods From July 2010 to October 2011,120 patients with varicose veins of the lower limbs were numbered according to the visiting sequence,every 10 patients were grouped as an unit to receive EVLT(EVLT group,n=60) or EVLT combined with foam sclerotherapy(combination group,n=60).In the EVLT group,after a high ligation of the great saphenous vein(GSV),the truck and tributary of the GSV and varicose vein cluster were treated with EVLT at a wavelength of 980 nm;while in the combination group,after a high ligation of the GSV,the truck of the GSV were treated with EVLT at a wavelength of 980 nm,and then sclerosing foam 5 ml(a mixture of 1 ml lauromacrogol injection with 4 ml air) were injected into the tributary of the GSV and varicose vein cluster.Results All the patients were followed up for 6-12 months(mean,9 months).In the EVLT group,56 patients were cured,the other 4 were improved(total effective rate was 100%).In the combination group,58 patients were cured,2 were improved(total effective rate 100%).No significant difference existed in the efficacy(Z=-0.834,P=0.404),nor in the rate of recurrence 6.7%(4/60) vs.3.3%(2/60),χ2=0.175,P=0.675] between the two groups.The rate of complications of the EVLT group was significantly higher than that in the combination group 35.0%(21/60) vs.3.3%(2/60),χ2=19.417,P=0.000].Conclusion EVLT combined with foam sclerotherapy is as effective as EVLT alone,but results in less complications.