CAJ | 학술논문

目的探讨腔镜交通静脉结扎对治疗CEAP分级CA ～ C6级的下肢慢性静脉功能不全的中长期疗效.方法回顾性分析82例慢性静脉功能不全患者的临床资料,根据治疗方式的不同分为A、B2组:A组为交通静脉结扎组(SEPS组),B组为非交通静脉结扎组(非SEPS组).所有患者根据临床症状体征及彩超或顺行性静脉造影确诊,术后CEAP临床分级、CEAP临床症状评分、累积溃疡愈合率及累计溃疡复发率评估两组不同手术方式的疗效.结果术前2组患肢的CEAP临床分级、CEAP临床症状评分差异无统计学意义(P＞0.05).术后2年,A、B组患肢肿胀、脂肪硬化症及静脉性溃疡等症状CEAP临床分级差异有统计学意义(P＜0.05).术后3、5年,A组肿胀、愈合性溃疡、活动性溃疡患肢少于B组(P＜0.05).A组与B组术后总临床症状评分差异有统计学意义,A组肿胀、色素沉着、溃疡等症状缓解明显优于B组(P＜0.05).Kaplan-Meier分析,2组的溃疡的中位愈合时间分别为2.3、3.7个月；Log-rank检验对组间累积溃疡愈合率远期差异敏感(x2=4.063,P=0.044)；而Breslow检验对组间累积溃疡愈合率近期差异敏感(x2=5.471,P=0.019).术后A组患肢累积溃疡愈合率显著高于B组(P＜0.05),而B组累积溃疡复发率显著高于A组(P＜0.05).结论浅静脉切除联合交通静脉结扎显著增强临床疗效,促进溃疡愈合,中长期溃疡复发率明显降低,疗效优于单纯浅静脉手术.
목적 탐토강경교통정맥결찰대치료CEAP분급CA ～ C6급적하지만성정맥공능불전적중장기료효.방법 회고성분석82례만성정맥공능불전환자적림상자료,근거치료방식적불동분위A、B2조:A조위교통정맥결찰조(SEPS조),B조위비교통정맥결찰조(비SEPS조).소유환자근거림상증상체정급채초혹순행성정맥조영학진,술후CEAP림상분급、CEAP림상증상평분、루적궤양유합솔급루계궤양복발솔평고량조불동수술방식적료효.결과 술전2조환지적CEAP림상분급、CEAP림상증상평분차이무통계학의의(P＞0.05).술후2년,A、B조환지종창、지방경화증급정맥성궤양등증상CEAP림상분급차이유통계학의의(P＜0.05).술후3、5년,A조종창、유합성궤양、활동성궤양환지소우B조(P＜0.05).A조여B조술후총림상증상평분차이유통계학의의,A조종창、색소침착、궤양등증상완해명현우우B조(P＜0.05).Kaplan-Meier분석,2조적궤양적중위유합시간분별위2.3、3.7개월；Log-rank검험대조간루적궤양유합솔원기차이민감(x2=4.063,P=0.044)；이Breslow검험대조간루적궤양유합솔근기차이민감(x2=5.471,P=0.019).술후A조환지루적궤양유합솔현저고우B조(P＜0.05),이B조루적궤양복발솔현저고우A조(P＜0.05).결론 천정맥절제연합교통정맥결찰현저증강림상료효,촉진궤양유합,중장기궤양복발솔명현강저,료효우우단순천정맥수술.
Objective To evaluate the mid- and long-term efficacy of subfascial endoscopic perforator surgery (SEPS) in the treatment CEAP classification C4 - C6 of primary chronic venous insufficiency(CVI). Methods Clinical data of 82 cases of chronic venous insufficiency were analysed retrospectively. According to operative method adopted,patients were divided into group A in which perforator veins were ligated under subfascial endoscopic surgery (SEPS group ),and group B in which perforator veins were not ligated (non-SEPS group).Diagnosis was established by clinical symptoms,color Doppler or ascending venography in all patients.Postoperatively patients were followed up regularly.The clinical outcomes between different surgical methods in two groups were assessed by CEAP clinical classification,CEAP clinical symptom scores,cumulative ulcer healing rate and cumulative ulcer recurrence rate. Results No significant differences were found in CEAP clinical classification,CEAP clinical symptom scores between the two groups preoperatively ( P ＞ 0.05 ). There were significant differences in CEAP clinical classification such as edema,lipodermatosclerosis,venous ulceration between the two groups on 2 years postoperatively (P ＜ 0.05 ).The amount of swelling limbs,healed ulceration,active ulceration in group A was less than group B (P ＜ 0.05 ) on 3' and 5' years postoperatively.Significant differences were found postoperatively in total clinical symptom scores between group A and B.Clinical symptoms such as swelling,lipodermatosclerosis,ulcer healing in group A relieved more markedly than group B ( P ＜ 0.05 ).The median healing time of ulcers was 2.3 and 3.7 months respectively in group A and B.Log-rank test on group differences was sensitive to long-term cumulative ulcer healing rate ( x2 =4.063,P =0.044).But Breslow test on group differences was sensitive to early cumulative ulcer healing rate ( x2 =5.471,P =0.019).Cumulative ulcer healing rate in group A was significantly higher than in group B postoperatively (P ＜ 0.05 ).The cumulative ulcer recurrence rate in group A was significantly lower than group B (P ＜ 0.05). Conclusions Superficial vein resection combined with perforator vein ligation significantly enhanced clinical efficacy,accelerated ulcer healing and decreased mid- and long-term ulcer recurrence rate.