DSA引导下经导管聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的临床疗效观察

目的 探讨DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡的技术方法、可行性、安全性和临床疗效.方法 选择36例(48条患肢)下肢静脉曲张伴溃疡的患者,患肢溃疡面平均为(3±1.5)cm2(1 ～7 cm2),均为内踝处溃疡.术中于腹股沟小切口高位结扎大隐静脉主干后,经大隐静脉远侧断端或经皮穿刺患肢内踝处大隐静脉,置入4F造影导管,DSA引导下经导管注入聚桂醇泡沫硬化剂,选择性硬化闭塞大隐静脉及交通静脉,术后患肢加压包扎、应用抗生素、局部换药.结果 在DSA引导下48条患肢均成功注入泡沫硬化剂,每条患肢平均注入6.5 ml(3.5～8.5 ml)泡沫硬化剂,无严重并发症发生.术后当日患者能下床活动.两周后,38条患肢(79.1％)下肢溃疡创面愈合,8条患肢(16.7％)溃疡创面明显缩小,2条患肢(4.16％)创面未扩大.6 ～12个月后随访:45条患肢(93.8％)曲张静脉及溃疡消失,3条患肢(6.25％)溃疡复发.结论 DSA引导下经导管注入聚桂醇泡沫硬化剂治疗下肢静脉曲张性溃疡临床疗效满意,是一种安全、有效的治疗下肢静脉曲张性溃疡的微创方法.     

一种激光微创治疗下肢静脉淤积性溃疡的新方法——辐条式穿刺激光光凝

目的探讨辐条式穿刺激光光凝微创治疗下肢静脉淤积性溃疡,比较其与传统手术方法的优缺点。方法 2014年1月至2018年4月,下肢静脉淤积性溃疡患者31例,采用辐条式穿刺激光光凝微创治疗。同时选取同期同龄溃疡大小无差异的患者31例,作为对照组,采用传统的手术方法进行治疗。记录两组患者的手术时间、切口大小、出血量、切口疼痛情况,以及术后溃疡愈合速度,连续随访1～2年,分析比较两组治疗效果和不良反应。结果所有病例手术进行顺利。辐条式穿刺组手术时间、手术切口和手术出血量均明显少于传统手术对照组(P0. 01);术后辐条式穿刺激光微创手术组溃疡愈合速度明显快于传统手术组,且无皮瓣坏死病例,而传统手术组则出现3例。术后疼痛辐条式穿刺微创激光手术组较传统手术组轻微(P0. 05),术后瘢痕激光治疗组下肢股部以下无瘢痕(发生率0%),而传统手术组下肢可见多处瘢痕(发生率100%),影响美观。两组患者均达到临床治愈,组间比较差异无统计学意义(P0. 05),随访1～2年均无复发病例。结论辐条式穿刺激光光凝微创疗法能够较好地治疗下肢静脉淤积性溃疡,与传统手术比较,具有操作简单、创伤小、溃疡愈合快,术后反应轻,并发症少的优点,值得推广应用。     

微波血管腔内闭合术结合中医治疗下肢静脉性溃疡

正下肢静脉性溃疡是下肢慢性静脉功能不全最严重的并发症,占小腿溃疡的80%左右[1]。下肢静脉性溃疡好发于小腿中下段前内侧面,即足靴区,其次是内踝、外踝和足背区,其发病机制与小腿交通静脉功能不全密切相关[2]。当下肢静脉高压时,深静脉血流通过功能不全的交通静脉逆流进入浅静脉,同时不可避免地继发或加重交通支瓣膜功能不全,造成由     

静脉切开术的改进

静脉切开术是常用的基本技术之一,在静脉穿刺困难、失败或急需建立静脉通路时,时有找不到静脉或将静脉误伤的错误。我们采用下述改进方法,认为优于常规静脉切开术,现介绍如下。 以内踝前方大隐静脉为例,先在小腿中部扎一橡皮止血带,以能阻断静脉回流为度,然后常规消毒铺单。在内踝前方大隐静脉之上设计纵行切口,长1.5～2cm。切皮前,用手指将皮向内踝上牵拉,使皮切口移至内踝处。用刀一次切开直达骨膜表面,然后松开手     

经导管硬化治疗下肢静脉曲张的临床疗效观察

目的：了解经导管注入无水乙醇治疗下肢静脉曲张的临床疗效和安全性。方法：23例25条曲张的下肢静脉，在患肢内踝上方约1～2cm处穿刺大隐静脉，插入导管至大隐静脉和股静脉连接点下方约3-4cm处，并压迫大隐静脉和股静脉连接点，在DSA监视下，边退导管边缓慢注入无水乙醇（每条患肢注射乙醇总量15～20ml），同时用对比剂监控栓塞程度，至整个大隐静脉完全栓塞为止。结果：23例患者随访3～12个月，行多普勒超声复查，25条栓塞的大隐静脉未见血流通过。患者术后3～7d曲张的静脉均塌陷；2～3周临床症状明显减轻；2例小腿溃疡于术后4～6周愈合。20条腿术后第2天出现轻度肿胀，1～2周内均消失；4例术后第3天，接受手术的下肢出现迟发性感觉异常，2周内恢复正常。无一例深静脉血栓、肺栓塞等并发症发生。结论：经导管注入无水乙醇栓塞治疗下肢静脉曲张创伤小、并发症少，近期疗效确切，远期疗效需进一步观察。     

下肢深静脉瓣膜功能不全激光微创综合治疗10年以上长期随访观察

目的观察微切口瓣膜修复联合血管内激光光凝治疗原发性下肢深静脉瓣膜功能不全的10年以上远期疗效,探讨激光微创综合治疗下肢深静脉瓣膜功能不全的临床经验。方法回顾性总结2001~2007年,收治的下肢深静脉瓣膜功能不全患者1 049例临床资料,包括原发性下肢深静脉瓣膜功能不全肢体1 159条。硬膜外麻醉取股部微小切口,第一对股浅静脉瓣膜外修复;以波长810 nm半导体激光对迂曲扩张的浅静脉进行血管内光凝术。手术后每年进行随访观察,利用超声多普勒确认治疗后的浅静脉是否闭合、深静脉是否反流。结果术后恢复顺利,微切口愈合良好,曲张静脉消失、溃疡愈合,无深静脉血栓形成、淋巴漏等严重并发症。术后6个月检查评估,临床治愈98.9%。全部病例获得10年以上连续随访,术后1年治愈率98.0%,5年治愈率94.9%,8年治愈率92.9%,10年治愈率为91.3%,15年治愈率81.7%。术后5年、10年下肢出现明显浅静脉迂曲扩张者7例和11例,采用多点穿刺植入光纤激光光凝治疗,对网状扩张的血管辅以硬化剂治疗,均治愈。结论激光微创综合治疗原发性下肢深静脉瓣膜功能不全是一种较好的微创治疗方法,效果稳定,10年以上远期疗效好。     

大隐静脉高位结扎联合腔内激光闭合和Muller术治疗C4～6级原发性下肢浅静脉曲张及其合并症防治

目的探讨大隐静脉高位结扎联合腔内激光闭合(endovenous laser treatment,EVLT)和Muller术治疗C4～6级原发性下肢浅静脉曲张及其并发症的治疗和预防。方法回顾性分析了95列(146条肢体)临床分级C4～6级的下肢浅静脉曲张患者的住院资料。结果95例患者146条下肢顺利完成手术,其中2条下肢发生导丝经小腿交通支进入股深静脉,1条下肢术后当天Muller切口持续渗血,术后8条下肢大隐静脉主干发生血栓性静脉炎,7条下肢出现隐神经热损伤,1条下肢激光损伤大隐静脉行程皮肤,2条下肢术后出现腹股沟区域血肿,2条下肢术后发生足背凹陷性水肿,1条下肢出现Muller切口下脂肪液化,1条下肢出现muller切口线头排异反应。对症处理后上述并发症均消失。结论大隐静脉高位结扎联合EVLT和Muller术治疗C4～6级原发性下肢浅静脉曲张,规范手术流程和注意细节可减少并发症甚杜绝发生严重的并发症的发生。     

腔内激光疗法联合高压氧治疗下肢大面积淤滞性溃疡24例疗效观察

目的观察静脉腔内激光疗法联合高压氧治疗下肢淤滞性溃疡的临床应用价值。方法下肢淤滞性溃疡患者24例,行静脉腔内激光处理大隐静脉主干,并烧灼溃疡面下的曲张静脉及交通静脉,术后弹力绷带、弹力袜加压包扎,高压氧治疗。结果 24例溃疡均于6～8周内愈合,随访最长36个月,未见溃疡复发。结论静脉腔内激光疗法联合高压氧治疗下肢淤滞性溃疡疗效显著。     

静脉腔内激光术联合手术治疗下肢静脉曲张

目的探讨静脉腔内激光术治疗下肢静脉曲张的安全性、临床疗效、并发症及其防治措施。方法超声检查证明的隐股静脉返流的下肢静脉曲张患者198例(235条肢体),分别采取静脉腔内半导体激光术(EVLT)联合股浅静脉第一对瓣膜修复、大隐静脉高位结扎及交通支结扎术治疗。结果术后患者恢复良好,手术并发症主要包括皮肤灼伤18例,小腿皮肤麻木6例,皮下血肿7例。超声随访可见EVLT静脉管壁回声增强,管腔内充满实性回声,未见血流信号。随访4~28个月,其中6例在术后1~2个月出现小腿局部曲张静脉复发;其余均未见复发。结论EVLT联合手术是治疗下肢静脉曲张的安全、有效的方法,达到在保证疗效的前提下减小创伤的目的。     

半导体激光照射治疗下肢静脉性溃疡临床观察及护理

正下肢静脉性溃疡是下肢静脉疾病病情进展中较严重的并发症,溃疡难治愈,易复发,严重影响患者的生活质量。2005年1月至2013年12月,笔者采用半导体激光局部照射治疗下肢静脉性溃疡患者86例,配合精心护理进行治疗,取得了较满意的疗效,现报告如下。     

腔内激光疗法治疗大隐静脉曲张100例

目的探讨静脉腔内激光疗法治疗下肢静脉曲张的临床疗效。方法回顾分析2009年6月至2010年6月100例124条肢体大隐静脉曲张行腔内激光治疗疗效及预后。结果一次治愈率95.2%（118/124）。1例1条肢体于术后1个月复发。5例5条肢体术后仍有少量曲张静脉存在。18例大隐静脉主干烧灼处条索状硬结、疼痛;15例发生皮下片状淤血;12例出现局部皮肤麻木。术后平均住院时间3 d。95例随访2~14个月,失访5例。结论腔内激光疗法治疗大隐静脉曲张疗效确切,创伤小。     

Endovenous laser treatment of incompetent below-knee great saphenous veins

PURPOSE: To test the hypotheses that below-knee great saphenous vein (GSV) reflux after successful ablation of the incompetent above-knee GSV is a cause of incomplete clinical success and that endovenous laser treatment (ELT) of the incompetent below-knee GSV can safely eliminate persistent symptoms. MATERIALS AND METHODS: The author evaluated 576 consecutive ELT procedures of the GSV. Fifty ELT procedures in incompetent calf GSVs were included in this study. Patients with reflux of the entire GSV were selected. All patients underwent clinical and ultrasonographic (US) follow-up. RESULTS: In 16 of the 50 procedures, ELT was performed in the GSV both above and below the knee in separate sessions. In 34 procedures, ELT of the GSV above and below the knee was performed at the same session. An 810-nm laser was used at 14 W. The mean energy was 82 j/cm (range, 56.4-114 j/cm; standard deviation [SD], 14 j/cm). The mean follow-up was 11 months (range, 0-28 months; SD, 7 months). Four paresthesias occurred. Medial ankle pain resolved in all patients, and swelling resolved in all but six limbs. No recanalization occurred. CONCLUSIONS: Patients with incompetence of the entire GSV treated with only ELT of the above-knee GSV experienced incomplete relief of medial ankle pain and swelling; however, symptomatic relief is obtained safely and effectively with additional ELT of the below-knee GSV.     

下肢浅静脉曲张激光治疗术后复发的临床分析

目的 探讨腔内激光治疗下肢浅静脉曲张术后复发的原因及防治方法.方法 回顾性分析353例(415条肢体)下肢静脉曲张患者的临床资料.结果 38例(40条肢体)患者术后复发,复发率为9.64%.复发原因分别为:18条肢体交通支功能不全,14条肢体大隐静脉主干再通,5条肢体小隐静脉主干未处理,2条肢体深静脉瓣膜功能不全,1条肢体双大隐静脉畸形.38例患者均经再次手术,分别随访1～4年无复发.结论 根据静脉曲张程度和病因采取针对性手术,重视过度扩张大隐静脉的高位结扎和交通支血管的处理是预防术后复发的关键.     

Prospective evaluation of higher energy great saphenous vein endovenous laser treatment

PURPOSE: In this study, the hypothesis that higher energy dose improves procedural success without increasing complications was prospectively evaluated by performing endovenous laser therapy (ELT) at energies greater than 80 J/cm. MATERIALS AND METHODS: One hundred consecutive great saphenous (GSV), anterior accessory great saphenous (AAGSV), or posterior accessory great saphenous (PAGSV) veins were treated with the intent to deliver an energy dose of greater than 80 J/cm. Eighty-one patients (64 women, 17 men) were treated. Mean age was 49 years (range, 25-77 years; SD, 12 years). Ultrasound (US) and clinical follow-up was performed at 1 week, 3, 6, 9, and 12 months until all veins had at least 3 months of follow-up. Success was defined as absence of reflux throughout the entire treated segment on follow-up US and clinical resolution of symptoms. Incomplete vein ablation was defined as US evidence of flow in a segment of a treated vein at any point during the follow-up period. RESULTS: One hundred veins were treated with an average energy of 95 J/cm (range, 57-145 J/cm; SD, 16 J/cm). Follow-up and success at 1 week was 100%. Four veins could not be followed up beyond 1 week. Of the 96 remaining veins all had 3 months follow-up with an average follow-up of 9 months (range, 3-13 months; SD, 4 months). There were five failures and 91 successes for a success rate of 95%. Four of the treatment successes demonstrated segmental patency but no reflux on US for a complete vein ablation rate of 91%. No major complications occurred. The treatment failures occurred at an average energy dose of 98 J/cm. Two of the three failures were AAGSVs, one was a GSV ipsilateral to one of the failed AAGSVs, and two were bilateral GSVs treated during the same procedure. Average body mass index (BMI) was 30 for the successes and 46 for the failures. This difference was statistically significant (P = .0009). The mean length of the failed treatments from the saphenofemoral junction to their termination into a varicose tributary was 10.9 (range, 8-15 cm; SD, 3.7 cm). This was significantly less than the length of the successful treatments (P = .000003). CONCLUSION: Higher energy GSV ELT is safe and highly successful.     

门脉系静脉血栓形成的流变溶栓序贯治疗效果分析

目的评价流变溶栓序贯治疗门脉系静脉血栓形成的临床疗效。方法11例门脉系静脉血栓形成病例经流变溶栓序贯治疗,包括血管腔内成形术、内支架植入术进行门静脉开通治疗,观察门静脉再通、临床症状缓解和并发症发生情况。结果10例开通成功,开通率90.9%。整个流变溶栓过程所需时间<30 m in,5例溶栓后对基础狭窄行经皮血管腔内成形术,2例行内支架治疗,无并发症发生,随访5~14个月,均生存无复发。结论流变溶栓治疗门静脉系血栓形成具有损伤小、溶栓能力强的特点;结合序贯治疗方案,则更加合理,治疗效果更明确、持久。     

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (κ) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo. O.A. Meissner and C.-G. Schmedt contributed equally to this work     

下肢远端静脉动脉化治疗缺血性糖尿病足

目的：探讨缺血性糖尿病足的治疗.方法：对26例（29肢）腘动脉以下广泛性闭塞或狭窄,采用膝关节下静脉动脉化,7肢为近端动脉重建后远端静脉动脉化.其中浅静脉型11（大隐静脉6,大隐＋小隐3,小隐2）肢,深静脉型18（胫腓干12,胫后3,胫腓静脉成形后3）肢.结果：经3月～10年随访,除2肢半足截肢外,均保存了肢体功能.结论：该手术对肢体缺血症状解除快,对静脉回流影响小,可分期完成也可一期完成,适应证广.     

准分子激光角膜切除术治疗角膜瘢痕

目的 探讨准分子激光治疗角膜瘢痕的临床应用。方法 对12例（12眼）角膜前基质层瘢痕行治疗性激光角膜切除术（phototherapeutic keratectomy,PTK),并对其手术效果进行了回顾性分析研究。 结果 随访6－12个月,12例（12眼）角膜瘢痕减轻,11眼视力有不同程度的提高。结论 准分子激光能有效地切除角膜浅层的瘢痕,而无继发于行激光治疗后的显著角膜混浊,手术方法简便、安全。     

激光治疗大隐静脉曲张

目的探讨激光治疗静脉曲张的方法,总结激光光凝大隐静脉曲张的临床经验。方法大隐静脉曲张患者283例,其中单纯大隐静脉曲张278例,同时伴有轻度胭静脉返流5例。内踝部切口1cm,显露大隐静脉,使用810nm波长的半导体激光器,利用5F导管将光纤(直径400μm)送入大隐静脉内,行血管内激光光凝。激光功率12W,照射1s,间隔1s。结果术后当天既自由活动,术后8d拆线,切口愈合良好,肢体活动自如,无皮肤灼伤、皮下血肿和下肢水肿。随访6-22个月,平均14个月,超声检查大隐静脉均已闭塞,无复发或再通现象,局部皮肤营养障碍性病变明显减轻,浅静脉曲张完全消失,下肢酸胀感减轻或消失。结论激光治疗大隐静脉曲张,操作简便、创伤小、美观、恢复快,是一种较好的治疗大隐静脉曲张的微创方法,值得推广应用。     

负压封闭技术治疗创伤后软组织缺损

目的 探讨负压封闭技术（VS）治疗创伤后软组织缺损的疗效。方法 42例（48个创面）接受VS治疗，清创后将威克伤（Vacuseal)材料覆盖在相应大小的创面上或创腔内，维持负压在50－60kPa之间，5－7天后二期缝合，植皮或皮瓣转移。结果 42例完全治愈，无全身和局部并发症。与传统换药方法比较，在二期缝合的时间、换药次数、创面缩小程度及总体治疗费用等方面均有显著差异（P＜0．01）。48个创面中，直接通过VS治愈6个，采用游离皮瓣关闭4个，局部转移皮瓣关闭8个，植皮关闭25个，二期缝合5个。结论 VS治疗能防止创面污染、充分引流、刺激创面肉芽生长、缩短疗程和消除感染。对创伤后急、慢性软组织缺损是一种简单、有效的治疗方法。