点式引流手术在下肢慢性静脉功能不全伴脂质硬皮症中的疗效

摘要

Objective:To explore the efficacy and feasibility of percutaneous point incision dralnage in patients with chronic venous insufficiency(CVI) combined with lipodermatosclerosis(LDS) .Methods:A total of 60 patients with CVI combined with LDS were randomly divided into the experiment group and the control group ,with 30 patients in each .High ligation and stripping on superficial veins of lower limbs and ligation on perforating veins of lower limbs combined with percutaneous point incision dralnage were conducted in the experiment group ,while high ligation and stripping on superficial veins of lower limbs and ligation on perforating veins of lower limbs was conducted in the control group .The thickness of subcutaneous sclerosis , the venous clinical severity score(VCSS) ,the chronic venous insufficiency questionnalre(CIVIQ) and the level of transforming growth factor‐β1(TGF‐β1) were compared between the two groups after the operations .Results:After the operations ,the patients had been followed up for 6 to 12 months with an average of 8 .6 months ,and the follow‐up rate was 100% .The clinical manifestation of LDS in the experiment group was relieved faster than that in the control group .There were 7 cases ,2 cases with subcutaneous induration at 3 months ,6 months after operation ,respectively ,in the experiment group ,while there were 22 cases ,15 cases ,respectively ,in the control group(P<0 .01) .VCSS was lower ,while CIVIQ was better ,in the experiment group ,than that in the control group ,at 1 ,3 ,6 month after surgery(P<0 .01) .The level of TGF‐β1 in the experiment group was significantly lower than that in the control group at 1 month after surgery (P< 0 .05) .Conclusions:High ligation and stripping on superficial veins of lower limbs and ligation on perforating veins of low limbs ,combined with percutaneous point incision dralnage ,demonstrated a good efficacy on CVI combined with LDS .%目的：探讨点式引流手术在下肢慢性静脉功能不全（chronic venous insufficiency ，CVI ）伴脂质硬皮症（lipodermatosclerosis ，LDS）患者中的疗效和可行性。方法：将60例CVI伴LDS患者随机分为试验组和对照组，各30例。试验组行下肢浅静脉高位结扎剥脱术、浅静脉抽剥术和交通静脉结扎术联合LDS病灶点式引流手术治疗；对照组仅行下肢浅静脉高位结扎术、浅静脉抽剥术和交通静脉结扎术。比较2组患者术后皮下硬结厚度、临床严重程度评分（venous clinical severity score ，VCSS）、生活质量调查量表（chronic venous insufficiency questionnaire ，CIVIQ）评分及术后下肢静脉血中转化生长因子β1（transforming growth factor‐β1，TGF‐β1）浓度的差异。结果：术后随访6～12个月，平均8．6个月，随访率100％。试验组患者术后LDS临床表现先于对照组缓解消退。术后3、6个月时试验组仅分别有7、2例仍有皮下硬结，而对照组仍有22、15例，P＜0．01。术后1、3、6个月时，试验组VCSS评分低于对照组、CIVIQ评分优于对照组（P＜0．01）。术后1个月时试验组TGF‐β1明显低于对照组（P＜0．05）。结论：下肢浅静脉高位结扎术、浅静脉抽剥术和交通静脉结扎术联合LDS病灶点式引流手术，对CVI伴LDS患者有较好的疗效。