Hans Journal of Surgery
Vol.
08
No.
01
(
2019
), Article ID:
28562
,
5
pages
10.12677/HJS.2019.81004
Early Surgical Treatment of Superficial Thrombophlebitis of Lower Extremity
Yanpeng Zhu, Yingcheng Bai*, Weihua Li
Department of General Surgery, 971 Hospital of Chinese People’s Liberation Army, Qingdao Shandong
Received: Jan. 2nd, 2019; accepted: Jan. 15th, 2019; published: Jan. 22nd, 2019
ABSTRACT
Objective: To probe into the early operation of the clinical curative effect of surgical treatment of superficial thrombophlebitis of lower extremity. Methods: From August 2007 to December 2016, 256 patients with lower extremity thrombophlebitis treated surgically in our hospital were divided into two groups: the experimental group with early operation (148 cases) and the control group with anti-inflammation and anticoagulation for 1 week before reoperation to compare the therapeutic effect of two groups. Results: The hospitalization time, hospitalization expenses, duration of thrombotic pain and intraoperative bleeding in the experimental group were less than those in the control group (p < 0.01); the incidence of complications such as subcutaneous hematoma, burning pain and saphenous nerve injury in the experimental group were lower than those in the control group (p < 0.05); and the incidence of thermal blisters was lower (p < 0.01). Conclusion: Early operation of lower extremity thrombophlebitis has a significant effect, which can significantly shorten the treatment time, treatment cost and pain duration, reduce postoperative complications, and is more conducive to the rehabilitation of patients.
Keywords:Superficial Thrombophlebitis, Early Operation, Anti-Inflammatory and Anticoagulant before Surgery, Lower Extremity
下肢血栓性浅静脉炎的早期手术治疗
朱延朋,白英成*,李伟华
中国人民解放军971医院普外科,山东 青岛
收稿日期:2019年1月2日;录用日期:2019年1月15日;发布日期:2019年1月22日
摘 要
目的:探究下肢血栓性浅静脉炎早期手术的临床疗效。方法:选取2007.8~2016.12在我院就诊并手术治疗的256例下肢血栓性浅静脉炎患者,分为直接手术的实验组148例,抗炎、抗凝1周再手术的对照组108例,比较两组的治疗效果。结果:实验组患者的住院时间、住院费用、血栓性疼痛持续时间、术中出血量均少于对照组(p < 0.01);实验组患者术后皮下血肿、烧灼性疼痛、隐神经损伤等并发症发生率均低于对照组(p < 0.05);而热力水泡的发生率则更低(p < 0.01)。结论:下肢血栓性浅静脉炎早期手术效果显著,能明显缩短治疗时间、治疗费用及疼痛持续时间,降低术后并发症,更利于患者的康复。
关键词 :血栓性浅静脉炎,早期手术,抗炎抗凝后手术,下肢
Copyright © 2019 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
1. 引言
下肢血栓性浅静脉炎是血管外科常见的一种静脉疾病,该病发病急,病痛持续时间长,但治疗方法较为传统 [1] [2] 。目前国内大部分医院依然沿用先抗炎、镇痛1~2周,待炎症逐渐消退后再行手术切除曲张静脉及血栓的方法 [3] [4] ,其治疗周期、治疗费用居高不下。而我院2007.8~2016.12采用直接手术切除曲张静脉及血栓的治疗方法,取得了良好的治疗效果。现报告如下。
2. 一般情况
2.1. 一般资料
256例局限性血栓患者,分为实验组(直接手术) 148例,对照组(抗炎并抗凝7天后手术) 108例。男151例,女105例,男女比1.4:1,年龄21~81 (57.2 ± 8.5)岁。左下肢225例,右下肢31例,左右下肢比:7.3:1。256例患者均以疼痛为主要表现,合并下肢皮肤色素沉着162例,皮疹并瘙痒52例,下肢肿胀者141例;术前疼痛持续时间2~15 (7.8 ± 2.9)天。对照组术前用青霉素(800万单位/次,2次/日)抗炎及低分子量肝素钠(0.4 ml/支,1/日)抗凝7天。两组术后均常规用低分子量肝素钠(0.4 ml/支,1/日)抗凝3天。术后两组均不用抗炎治疗。
2.2. 术前排查
静脉彩超明确下肢局限性浅静脉血栓形成,排除全程浅静脉血栓及深静脉血栓患者;排除中度、重度下肢深静脉瓣膜功能不全。排除合并高血压、冠心病、糖尿病、椎间盘突出、下肢动脉硬化等疾病患者,同时排除体质差难以耐受手术者。
2.3. 治疗方法
2.3.1. 手术方法
蛛网膜下腔麻醉,采用大隐静脉高位结扎、血栓段静脉剥除、下肢曲张静脉抽拨术,必要时给予半导体激光烧灼细而直的曲张静脉(直径 < 4 mm),同时激光烧灼皮肤色素沉着区基底的曲张静脉。
2.3.2. 术后处置
a) 体位:休息时平卧,并抬高患肢15˚;b) 抗凝:术后8小时始皮下注射低分子量肝素钙(0.4 ml/次,1/日),72小时后停肝素,开始口服拜阿司匹灵(100 mg/晚)至1月;c) 消肿:术后第一天始口服地奥司明片(0.9 g/次,2/日);d) 预防静脉血栓:术后早期翻身及足踝背伸锻炼,术后6小时即可下床轻微活动,并逐渐加大活动量;e) 所有患者术后均未行抗炎治疗;均于术后顺利出院。 f) 所有患者均行弹力袜支持半年 [5] [6] 。
2.4. 统计学处理
采用统计学软件SPSS20.0对所有资料进行分析处理,计数资料使用率(%)表示,用χ2进行检验,计量资料使用x ± s表示,用t进行检验,以p < 0.05为差异有统计学意义。
3. 结果
1) 实验组与对照组的住院时间、住院费用、血栓性疼痛持续时间、术中出血量的比较存在显著统计学意义(见表1),p < 0.01,进而证实直接手术患者的各项指标均低于抗炎后手术患者。
Table 1. Comparison of data of two groups of patients during hospitalization
表1. 两组患者住院期间各项数据的比较
2) 两组患者术后皮下血肿、烧灼性疼痛、隐神经损伤等并发症的发生率(见表2)比较,p < 0.05,两组具有明显统计学意义;而热力水泡并发症的比较,p < 0.01,更有显著统计学意义。提示早期手术术后并发症的发生率低。
Table 2. Comparisons of postoperative complications between the two groups
表2. 两组患者术后并发症发生率比较
术后6个月的随访看,两组患者均恢复正常运动,仅对照组遗留6例隐神经损伤引起的麻木不适,且进行性减轻;术后半年内复查,未见深静脉血栓形成及肺栓发生。
4. 讨论
血栓性浅静脉炎是一种良性静脉疾病 [7] ,好发于下肢浅静脉,系血液流变学变化、静脉炎症及静脉瓣膜功能不全等多因素所致。下肢浅静脉回流速度减慢、静脉瓣膜功能不全引起血液倒流增加,进而引起下肢血流淤滞及血液含氧量下降,血液内有害成份沿着薄弱的静脉管壁进入周围组织间隙内,刺激血管壁及周围组织发生炎性反应,最终导致管壁损伤,引起血小板聚集形成血栓 [8] [9] [10] [11] [12] 。该病若不及时治疗,血栓可迅速蔓延或直接脱落进入深静脉,轻者引起深静脉血栓形成,重者出现致命性的肺栓塞 [13] [14] [15] 。
浅静脉血栓与静脉管壁粘附力的高低,取决于血栓形成并存在的时间 [8] ,血栓形成时间越长,抗炎时间越久,血栓越不易脱落,但术中分离的困难增加,间接导致手术出血量增加;血栓形成时间过短,与周围组织的粘附轻,利于手术时剥离。表1中对照组术中出血量明显多于实验组,即说明此点。从临床角度看,早期手术重点防治血栓脱落,而抗炎后手术患者,重点在于血栓段血管分离及减少隐神经和周围组织的分离损伤。
近年来,随着新技术、新器材及药物的持续研究进展,下肢血栓性浅静脉炎先抗炎、抗凝再手术的传统治疗方法,因住院时间长、费用高,正在受到全新的挑战 [3] [4] ,不少医院的专家学者正在做血栓性浅静脉炎早期手术的临床试验,从临床、病患、医疗等多角度来观察血栓性浅静脉炎直接手术的利弊 [4] [16] [17] 。从我院实验组及对照组的术后并发症看(见表2),实验组术后并发症:皮下血肿、热力水泡、烧灼性疼痛、隐神经损伤的发生率均低于对照组,p < 0.05及0.01,统计学意义显著;而术中出血量、住院时间、血栓性疼痛持续时间、临床花费又均低于对照组(见表1),p < 0.01,进一步提示血栓性浅静脉炎早期手术的好处均优于先抗炎抗凝再手术,临床获益高。再从我院术后6个月的随访看,两组患者均能恢复正常运动,并发症基本痊愈,仅对照组遗留6例隐神经损伤引起的麻木不适;实验组因早期手术干预,减少了术后并发症的发生;术后1、3、6月均常规行下肢静脉彩超复查,全组未见1例出现下肢静脉血栓形成及肺栓发生。
下肢血栓性浅静脉炎应首选直接手术,该手术效果好,治疗周期短,治疗费用低,肢体疼痛持续时间短,并发症低,值得临床推广。
文章引用
朱延朋,白英成,李伟华. 下肢血栓性浅静脉炎的早期手术治疗
Early Surgical Treatment of Superficial Thrombophlebitis of Lower Extremity[J]. 外科, 2019, 08(01): 19-23. https://doi.org/10.12677/HJS.2019.81004
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NOTES
*通讯作者。