三种微创手术方法应用于大隐静脉曲张治疗的临床效果分析

摘要

Objective]To investigate the clinical performance of three minimally‐invasive surgery ways (New Minimally Invasive Stripper ,NMIS ;Transilluminated Powered Phlebectomy ,TIPP ;Endovascular Laser Ablation ,EVLA) in the treatment of varicosis of the great saphenous vein .[Methods]Retrospective analysis of 114 patients who were admitted in our hospital and received treatment between January of 2010 and December of 2013 .These patients were divided into three groups with 38 cases each .The three groups patients were trea‐ted with NMIS ,TIPP ,and EVLA plans .After treatment ,the effect was evaluated according to the standard and the data was analyzed statistically .[Results]The three kinds of minimally‐invasive surgery operation times were not significantly different ( t =3 5.62 ,P =0 7.35);however ,EVLA group of patients had the least blood loss ( t =19 0.25 ,P =0 0.15) and the shortest length of stay (t = 20 7.47 ,P = 0 0.09) .It was found that NMIS was the most economical ( t =12 9.32 ,P =0 0.41).After a statistical test ,the treatment efficacy score and postoperative pain score between three groups after surgery were also statistically significant ( P <0 0.5) .[Conclusion]The NMIS ,TIPP ,and EVLA plans in the treatment of varicosis of the great saphenous vein each had their own advantages and disadvantages :the NMIS plan was the most cost‐effective and is in general a preferred solution ;the TIPP plan required the smallest incision and was more aesthetic (especially for patients with severe varicose);the EVLA plan varicose applies to a lesser extent ,and is better for patients who have strongly financial support .%【目的】研究新型微创剥脱器（New minimally invasive stripper ，NM IS ）、透光旋切（T ransillumina‐ted Powered Phlebectomy ，TIPP）和腔内激光消融（Endovascular laser ablation ，EVLA）三大方案治疗大隐静脉曲张的临床效果。【方法】将本院2010年1月至2013年12月期间收治的共114例大隐静脉曲张患者分成NMIS组、TIPP组和EVLA组，各38例，治疗按NMIS、TIPP和EVLA方案执行，治疗后按标准进行疗效评定。【结果】三种微创手术的手术时间无显著差异（ t ＝35．62，P ＝07．35），EVLA组患者的术中出血最少（ t＝190．25，P ＝00．15），住院时间最短（ t ＝207．47，P ＝00．09），NMIS手术方案最为经济（ t ＝129．32，P ＝00．41）。经过统计检验，三组患者的术后治疗效果评分也存在着统计学差异，具有统计学意义（ P ＜00．5）。【结论】NMIS方案、TIPP方案和EVLA方案在大隐静脉治疗中各具特点，NMIS方案的综合疗效较好，性价比较高，可以作为优先选用的方案。TIPP方案切口小，较为美观，对于重度曲张患者尤为适用。EVLA则适用于曲张程度较轻，经济承受能力较强的患者。