To Investigate The Effect Of High-level Ligation Combined With Laser Intraluminal Coagulation On The Postoperative Early Recovery Of Exercise Capacity In Patients With Varicose Veins Of The Lower Limbs

Objective:In this study,we compared the differences in surgical-related indexes,complications,postoperative stress response,recurrence,and recovery of exercise capacity in patients with varicose veins of the lower extremities by using high ligation combined with laser endovascular coagulation and high ligation combined with varicose vein ablation.Based on this,we explored whether high-level ligation combined with laser intracoagulation can have a positive effect on the recovery of patients' early exercise ability.It is hoped to give better treatment to those patients who need to recover high intensity exercise early after surgery.Methods:This article took 40 patients with unilateral lower extremity varicose veins who met the inclusion criteria from July 2018 to July 2019 at the Chinese People's Liberation Army Joint Logistics and Security Unit 967 th Hospital.They were divided into observation group and control group according to the choice of operation methods,with 20 cases in each group.The observation group used high saphenous vein ligation + laser intraluminal coagulation,and the control group used high saphenous vein ligation + varicose vein ablation.Comparison of surgical-related indicators(number of incisions,surgical time,intraoperative blood loss,postoperative hospital stay),pain grading before and after 1,3,5,and 7 days(using visual analog scoring(visual analogue scale(VAS)),postoperative recovery of lower limb mobility(including the single maximum walking distance that did not cause significant discomfort on days 2,4,6,10,and 14 after surgery;number of single climbing steps that did not cause significant discomfort on days 3,5,7,11,and 15 aftersurgery),stress response before and after surgery,complications,and recurrence rates during 6-12 months of follow-up.Results:1.General information and data:Forty patients with unilateral lower extremity varicose veins that met the inclusion criteria were the study subjects,including 25 males and 15 females;aged 23 to 58 years,with an average(46.05±7.62)years of age;and a disease course of 3 to 15 years with an average(7.03±3.22)years;affected limb parts: left limbs in 21 cases,right limbs in 19 cases;CEAP classification: c3 grade 18 cases,c4 grade 18 cases,C5 grade 4 cases.They were divided into observation group and control group according to the choice of operation methods,with 20 cases in each group.There was no statistically significant difference between the two groups of patients in terms of gender,age,course of disease,affected limb area,CEAP classification(P> 0.05),and they were comparable.2.Research results show:2.1 Surgery-related indicators: The operation time and postoperative hospital stay in the observation group were significantly shorter than those in the control group,the number of incisions was significantly less than that in the control group,and the amount of intraoperative bleeding was significantly lower than that in the control group.(P <0.01).2.2 Pain grading: There was no significant difference in pain grading between the observation group and the control group before surgery(P> 0.05),and the pain grading of the postoperative group was significantly lower than that of the control group on the 1st,3rd and 5th days after the operation.The difference was statistically significant(P <0.05).There was no significant difference between the observation group and the control group on the 7th day after the operation(P> 0.05).2.3 Recovery of lower limb mobility after surgery:2.3.1 The maximum walking distance in the observation group that did not cause discomfort on the 2nd,4th,6th,and 10 th days after operation was significantly larger than that in the control group,and the difference was statistically significant(P <0.05).There was no significant difference in the maximum walking distance between the observation group and the control group on the 14 th day after surgery(P> 0.05);2.3.2 The number of climbing steps that did not cause discomfort on the 3rd,5th,7th,and 11 th days after the operation in the observation group was significantly larger than that in the control group,and the difference was statistically significant(P <0.05).On the 15 th day after the operation,there was no significant difference between the observation group and the control group(P> 0.05).2.4 Preoperative and postoperative stress response: There was no significant difference in serum inflammatory factor levels between the observation group and the control group 24 h before surgery(P> 0.05).48 hours after surgery,the serum inflammatory factor content of the two groups of patients was significantly higher than that before surgery,and the difference was statistically significant(P <0.05).The levels of inflammatory factors in the observation group were lower than those in the control group,and the difference was statistically significant(P <0.05)2.5 Complications and postoperative recurrence: Neither observation group nor control group had postoperative incision infection.Other complications such as hematoma ecchymosis,saphenous nerve numbness,and lower extremity edema were significantly lower in the observation group than in the control group.Due to the small number of samples,after statistical calculation,The difference was not statistically significant(P> 0.05).Follow-up visits were conducted by email,telephone,We Chat,outpatient appointment review,etc.for 6-12 months,with 6months as the end point of the first-stage return visit.During the follow-up period,no recurrence occurred in the observation group and the control group.Conclusion:1.High saphenous vein ligation + laser intracoagulation has relatively great advantages in shortening the operation time,the number of postoperative hospital stays,reducing the number of incisions,reducing the amount of intraoperative bleeding,reducing the degree of inflammatory stress response and improving the postoperative cosmetic effect.2.High saphenous vein ligation + laser intraluminal coagulation can significantly reduce the VAS pain score within 7 days after surgery,which is more conducive to early postoperative exercise and recovery of exercise capacity.3.High saphenous vein ligation + laser intraluminal coagulation is more conduciveto the recovery of exercise capacity in the short postoperative period(2-11 days of experimental data).For patients who urgently need to restore exercise capacity as soon as possible,high saphenous vein ligation plus laser intraluminal coagulation is a better treatment option.