| Objective: To explore the efficacy of subfascial inferior perforator surgery(SEPS)combined with traditional high ligation and excision of the great saphenous vein in the treatment of moderate primary chronic venous insufficiency of lower limbs,To provide clinical basis for the treatment and prognosis evaluation of moderate primary chronic venous insufficiency of lower extremities.Methods: In this study,184 patients with moderate primary chronic venous insufficiency of lower limbs who met the inclusion criteria and were admitted to the Department of Vascular Surgery of Yang Zhou City First People’s Hospital from May2020 to December 2021 were included.Patients were randomly divided into a control group receiving conventional surgery and a study group receiving SEPS combined with conventional surgery.There were 92 patients in the study group,including 50 males and42 females.The mean age of the patients was 64.53±8.67 years old,and the mean BMI was 25.00±2.47,with a total of 92 affected limbs.There were 92 patients in the control group,including 39 males and 53 females.The mean age of the patients was 63.18±9.91 years old,and the mean BMI was 25.10±2.62.There were 92 affected limbs.There were no significant differences in disease grade,age,gender and BMI between the two groups(P > 0.05).There is comparability between groups.Perioperative indexes(including intraoperative blood loss,operation time,blood removal time and hospital stay),postoperative complications during hospitalization and postoperative satisfaction scores were compared between the two groups.assessing disease specific quality of life(AVVQ)scores of the venous clinical severity score(VCSS)and assessing Disease Specific Quality of Life(AVVQ)were recorded.VCSS score,AVVQ score,incidence of infection,ulcer formation and other information were followed up 6 and 12 months later by outpatient and telephone follow-up.All patients completed the 12-month follow-up.The efficacy of the two kinds of treatment was evaluated comprehensively by comparing various evaluation indexes before and after the two kinds of surgery.The collected data were summarized,and the statistical software SPSS26.0 was used for statistical analysis of the sorted data results.Results:(1)The median amount of intraoperative blood loss in the study group was 25.5ml(24,28),while that in the control group was 26ml(24,28),and there was no statistical difference between the two groups(p = 0.754).(2)The median operation time of the study group was 67min(62.25,71),while that of the control group was 43min(40,46),and there was a statistical difference between the two groups(p<0.001).(3)The median blood displacement time of the study group was 32min(31,34),and that of the control group was 33min(30,34).There was no statistical difference between the two groups(p = 0.789).(4)The median length of hospital stay in the study group was 6d(5,7),and that in the control group was 6d(5,7),and there was no statistical difference between the two groups(p = 0.711).(5)The incidence of complications during hospitalization was compared between the two groups.The incidence of complications in the study group was 4.35%(1 case of saphenous nerve injury,1 case of pain in the affected limb,2 cases of fever),and that in the control group was 4.35%(1 case of saphenous nerve injury,2 cases of subcutaneous hematoma,1 case of poor wound healing),with no statistical difference(P > 0.05).(6)Comparison of discharge satisfaction between the two groups showed that the median satisfaction score of the control group was 4(3,5)and that of the research group was4(3,5),with no statistical significance(p=0.373).(7)The median VCSS score of the control group was 12(11,13.75)and that of the study group was 12(11,14).There was no statistical difference between the two groups in the overall VCSS score(p=0.531).6 months after surgery,the median VCSS score of the control group was 4(3,5),and that of the study group was 3(2,4).The overall VCSS score of the two groups was statistically significant(p<0.001).12 months after surgery,the median VCSS score was 3(2,4)in the control group and 1(0,2)in the study group.The overall VCSS score was significantly different between the two groups(p<0.001).(8)The median preoperative AVVQ score of the control group was 19(18,21.75)and that of the study group was 19(17,22).There was no statistical difference between the two groups in the overall preoperative AVVQ score(p=0.593).Six months after surgery,the median AVVQ score of the control group was 5(3,8),and that of the study group was5(5,7).There was no statistical difference in the overall AVVQ score between the two groups at six months after surgery(p=0.162).12 months after surgery,the median AVVQ score of the control group was 5(5,6.75),and that of the study group was 3(3,3).The overall AVVQ score of the two groups was statistically different 12 months after surgery(p<0.001).(9)6 months after operation,no infection or ulcer occurred in the two groups;12 months after operation,14 cases of infection or ulcer occurred in the control group,with an incidence of 15.2%;in the study group,no lower limb infection or venous ulcer occurred,with statistically significant differences between the groups(p <0.001).Conclusion: Endoscopic combined with traditional high level ligation and extraction of great saphenous vein in the treatment of moderate primary chronic venous insufficiency of lower limbs has better long-term efficacy than traditional surgery,which can not only reduce long-term postoperative complications,but also effectively improve the skin nutrition status and quality of life of patients,and prevent infection and ulcer.It is more suitable for patients with moderate primary chronic venous insufficiency of lower limbs,and is worthy of widespread promotion. |
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