日间手术模式下腔内射频消融术与静脉剥脱导管主干剥脱术治疗大隐静脉曲张疗效比较

目的 比较日间手术模式下大隐静脉腔内射频消融术与静脉剥脱导管主干剥脱治疗大隐静脉曲张的安全性及有效性.方法 收集2020年2月至2021年1月大连市金州区第一人民医院收治的84例行日间手术的大隐静脉曲张患者的临床资料,根据手术方式的不同将患者分为射频组(n=44,采用大隐静脉主干射频消融术+小腿浅表静脉泡沫硬化+部分小...     

改良大隐静脉曲张术式的探讨

改良大隐静脉曲张术式的探讨张海生，李建辉，米拉提，汪新洲，木拉提，周忠诚我们对单纯性大隐静脉曲张患者实行改良术共７１例。术后随访时间均超过半年以上，效果满意，现报告如下。临床资料单纯性大隐静脉曲张６７例中，男４８例，女１９例，年龄１７－５６岁，病程１...     

改良大隐静脉高位结扎剥脱术治疗原发性大隐静脉曲张的临床效果

目的 评价改良大隐静脉高位结扎剥脱术治疗原发性大隐静脉曲张的临床效果及安全性.方法 选取2019年1月至2019年6月首都医科大学附属北京潞河医院收治的89例原发性大隐静脉曲张患者临床资料,根据手术方法的不同将患者分为传统手术组(n=44)和改良手术组(n=45).两组患者均行单侧大隐静脉高位结扎剥脱术,传统手术组分别...     

大隐静脉曲张的日间手术技术进展

大隐静脉曲张是血管外科常见疾病,大量患者的治疗需求及手术技术的进步为积极开展日间手术提供了必要性和可行性。静脉腔内热闭合技术(激光闭合术和射频消融闭合术)及静脉腔内非热、非肿胀麻醉技术有创伤小、恢复快、并发症少的优势,且有效率和复发率情况不亚于结扎剥脱手术。硬化剂闭合术和点式剥脱技术是重要辅助手段。本文就大隐静脉曲张日...     

高位结扎加点式剥脱术治疗单纯大隐静脉曲张临床分析

目的观察应用高位结扎加点式剥脱术治疗单纯大隐静脉曲张的效果。方法将116例单纯大隐静脉曲张患者随机分为观察组和对照组,各58例。观察组实施高位结扎加点式剥脱术,对照组实施大隐静脉高位结扎加传统阶段性抽剥术。观察对比2组的治疗效果和术后并发症。结果观察组的出血量、下床活动时间和住院天数均显著低于对照组,观察组患者色素沉着、皮炎和溃疡的治愈率均高于对照组,差异有统计学意义(P<0.05)。观察组1年内复发2例(3.45%),对照组复发11例(18.97%),差异有统计学意义(P<0.05)。结论采用高位结扎加点式剥脱术治疗单纯大隐静脉曲张治愈率高,复发率低,效果肯定。     

早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张

目的探讨早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张的疗效。方法回顾性分析我院2008年10月～2011年5月32例大隐静脉曲张并发急性血栓性浅静脉炎的临床资料。发病2周内行小切口大隐静脉高位结扎剥脱术。结果全部患者术后局部红肿疼痛于3天内消退,切口全部甲级愈合,住院时间10～16d,平均12．6d。全部患者随访5～32个月,平均13．6月,其中11例〉12个月,未见复发。结论早期小切口大隐静脉高位结扎剥脱术治疗伴急性血栓性浅静脉炎的大隐静脉曲张是安全的,术后疗效满意。     

内翻式大隐静脉剥脱术的疗效评价

单纯性大隐静脉曲张是最常见的一种血管外科疾患 ,既往多采用高位结扎剥脱术 ,腹股沟部采用斜切口或纵切口 ,长约 4～ 6ｃｍ。剥脱主干后 ,对曲张严重的属支需另做切口剥脱 ,手术创伤相对较大 ,一般术后 1周下地。笔者自 2 0 0 0年 7月至 2 0 0 1年 11月 ,采用内翻式大隐静脉剥脱术 149例。均获得满意治疗效果。现将有关手术方法及相关问题介绍如下。临床资料1.一般材料 :本组男性 94例 ,女性 5 5例 ;年龄从 2 5～78岁 ,平均 5 3岁。单侧病变者 92例 ,双侧者 5 7例。采用局部麻醉者 45例 ,腰麻或硬膜外麻醉 10 4例。仅剥脱主干加膝下硬化治…     

改良式大隐静脉剥脱术的应用体会

目的:探讨大隐静脉曲张手术及麻醉方法的改进方案。方法:局麻下大隐静脉曲张高位结扎,血管床灌注自配复方镇痛止血液,上段剥脱至膝关节处,小腿段行交通支环扎术及曲张静脉注射硬化剂等综合治疗。结果:所有病人全部治愈,平均术后第2d出院,无1例出现术后并发症。结论:局麻下行大隐静脉曲张高位结扎剥脱术,手术简单安全,创伤小、痛苦小,恢复快,住院时间短、费用低,是一种行之有效的治疗大隐静脉曲张的手术方法。     

改进高位结扎剥脱术治疗单纯性大隐静脉曲张体会

目的总结单纯性大隐静脉曲张的治疗经验。方法回顾性分析我院2007年3月至2009年11月期间采用改进高位结扎及剥脱术治疗单纯性大隐静脉曲张65例患者的临床资料。结果本组患者手术时间45~127 min,平均54 min。住院时间5~8 d,平均6.8 d。所有切口均甲级愈合,肿胀不适、沉重感等症状消失,切口皮下无出血、瘀血、血肿,无皮肤麻木等并发症发生。术后随访2~33个月,平均26.9个月,无一例发生深静脉血栓形成,均按期拆线,效果良好,无复发。结论改进高位结扎剥脱术治疗单纯性大隐静脉曲张疗效确切。     

Neovascularisation is not an Innocent Bystander in Recurrence after Great Saphenous Vein Surgery

Introduction

This study sought to establish the causes of failure of great saphenous vein surgery among patients in whom there was confidence that accurate saphenofemoral ligation had been carried and the great saphenous vein had been stripped at least to knee level.

Methods

This was an observational study of 100 limbs (66 patients) operated on by a single surgeon 5–22 years previously (mean: 12 years). The index operation was primary in 54 limbs and for recurrence in 46 limbs. Thirty-two patients were studied having been re-referred for recurrence while 34 were recalled for review. All were examined clinically and with duplex ultrasonography, and all completed questionnaires (Aberdeen varicose vein questionnaire [AVVQ] and EQ-5D-3L). In order to measure the extent of visible recurrence, a scoring system similar to that in the venous clinical severity score was used but with a range of 0–8.

Results

There were visible varicosities in 77 of the 100 limbs. Duplex ultrasonography showed that recurrent saphenofemoral incompetence (SFI) was present in 27% of the limbs. This was judged to result from neovascularisation and was the most common source of reflux. AVVQ scores for the 27 limbs with recurrent SFI (median: 34, interquartile range [IQR]: 20–42) were higher than for the 73 with no recurrent SFI (median: 17, IQR: 11–29), which was a significant difference (Mann–Whitney U test, p<0.01). Analysing clinical scores with chi-squared tests indicated fewer visible varicosities in limbs without recurrent SFI than in those with recurrent SFI (p<0.01).

Conclusions

Neovascularisation remains poorly understood but it cannot be considered an innocent bystander.     

Long Saphenous Vein Stripping and Quality of Life – a Randomised Trial

OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group.     

Great Saphenous Vein Stripping with Liberal Use of Subfascial Endoscopic Perforator Vein Surgery (SEPS)

This study is based on a unique registry of 632 patients who underwent great saphenous vein (GSV) stripping and liberal use of subfascial endoscopic perforator vein surgery (SEPS) for minimal to severe lower limb venous insufficiency. Clinical examinations and color-coded duplex scanning were performed on a randomly selected, manageable sample of 170 limbs to assess the affect of early SEPS on junctional (saphenofemoral [SFJ] and/or saphenopopliteal [SPJ]) and perforator vein (PV) insufficiencies and superficial varicosities at a median of 6.5 years. PV incompetence was present in 68 legs (40%), as the sole transfascial insufficiency in 28 limbs and combined with SFJ or SPJ incompetence in 40 limbs. Junction incompetence alone characterized an additional 38 limbs, bringing the total transfascial insufficiency prevalence to 62%. Superficial varicosities affected 46% of limbs. Overall CEAP clinical class was unimproved beyond preoperative values. PV incompetence was associated with higher CEAP and clinical venous severity scores than were junctional insufficiencies alone. We concluded that PV incompetence alone or combined with junctional insufficiency is associated with increased symptoms and disease progression. The prevalence of SFJ, SPJ, and PV incompetence (62%) and recurrent varicosities (46%) suggests that early use of SEPS does not prevent disease progression and offers no benefit over GSV stripping in the absence of deep vein insufficiency or threatened ulceration.     

内窥镜游离与全程切开法静脉桥血管通畅率的初步研究

目的 比较冠状动脉旁路移植术(CABG)中内窥镜与全程切开法采集大隐静脉后静脉桥血管近、中期通畅率,分析影响静脉桥血管通畅率的危险因素.方法 回顾性分析解放军总医院2006年5月至2009年5月择期行CABG中采用内窥镜游离法制备大隐静脉60例(EVH组)的临床资料,其中男34例,女26例;年龄66.6±9.2岁.同期...     

微创伤切取大隐静脉方法在冠状动脉搭桥术中的应用

目的：探讨腔镜辅助的微创伤方法切取大隐静脉在冠状动脉搭桥术（CABG）病人应用的可行性，安全性及能否减少腿部的并发症。方法：29例应用大隐静脉CABG的病人中，采用传统方法切取大隐静脉16例，腔镜辅助的微创伤方法取材大隐静脉13例，比较两种方法在手术时间，所取大隐静脉的长度，有无损伤及术后腿部并发症等方面的差异。结果：两种方法对大隐静脉均无损伤，在单位时间取材大隐静脉长度无明显区别，但微创伤方法术后腿部并发症明显减少（P＜0．05），从25％降至7．6％，结论：采用腔镜辅助的微创伤方法切取大隐静脉是安全可行的，并能明显减少传统方法的腿部并发症。     

无功能性肾上腺肿瘤实施日间手术的可行性评估

目的探索对无功能肾上腺良性肿瘤患者实施日间手术的可行性、安全性及有效性。方法采用方便抽样的方法选取2018年11月至2019年11月瑞金医院日间病房实施手术的25例无功能肾上腺良性肿瘤患者作为实验组,并选取同期32例在瑞金医院泌尿外科实施常规住院手术的无功能肾上腺肿瘤患者作为对照组。实验组患者的术前检查、健康宣教、麻醉评估等医疗服务于门诊完成,在日间手术室行全麻下腹腔镜肾上腺肿瘤切除,术后进行常规护理,术后第2天8∶00在满足出院评估标准后出院。对照组患者的术前检查、健康宣教、麻醉评估等医疗工作按常规住院手术在入院后完成,在病房手术室行全麻下腹腔镜肾上腺肿瘤切除,术后进行常规护理,术后根据患者恢复情况经评估后出院。比较两组患者手术时间、住院时间、住院医疗费用、满意度等指标。结果实验组术前等待入院手术时间、住院时间、住院医疗费用均少于对照组,差异有统计学意义(P<0.05)。实验组患者出院后满意度(100%)高于对照组(93%)。两组均未发生明显的术后并发症。结论对于无功能肾上腺肿瘤患者开展日间手术和实施管理安全有效,且可大大提高医疗资源的利用率,是一种非常高效的手术医疗模式。     

A Prospective Study of Cutaneous Nerve Injury Following Long Saphenous Vein Surgery

OBJECTIVES: The aim of this study was to identify the incidence and distribution of nerve damage in patients undergoing primary venous surgery. METHODS: Patients undergoing primary great saphenous vein surgery between February and November 2003 were enrolled. In all cases the great saphenous vein was 'flush' ligated at the sapheno-femoral junction and stripped to the knee by inversion without using a stripper head; multiple phlebectomies were performed using an Oesch hook. A vascular nurse followed up patients 6 weeks post-operatively. Those reporting altered sensation and/or pain were examined by a doctor to provide an objective assessment of any neurological damage. These patients were again followed up by telephone at 6 and 12 months. RESULTS: Sixty-three limbs from 54 patients were enrolled. Numbness or paraesthesia was identified in 17 (27%) limbs at 6 week follow-up. 11 (17%) limbs were affected below the knee and 7 (11%) limbs were affected at the thigh or groin. One of the limbs was affected above and below the knee. Of these 17 limbs there was resolution in six limbs at 6 months and nine limbs at 12 months. Two patients with persistent nerve lesions regretted undergoing surgery. Patients undergoing bilateral surgery were more likely to report abnormal sensation (chi(2) test, p=0.006). There was no significant difference between the incidence of nerve injury for consultant, SpR or SHO as first operator (chi(2) test, p=0.9). CONCLUSION: This study demonstrates the frequency of nerve injury during primary great saphenous vein surgery. It will be useful for clinicians providing informed consent and may provide a benchmark for comparison with newer techniques.     

Comparative Study of Harvest-Site Complications Following Coronary Artery Bypass Grafting Between the Radial Artery and the Saphenous Vein in Identical Patients

Purpose The aim of this study was to assess the early outcome for complications associated with the radial artery harvest site, in comparison to using the saphenous vein, in patients harvested for both vessels.Methods During the last 2 years, 134 radial arteries were used in 133 patients, and the saphenous vein was also concomitantly used in 94 patients. We assessed the post-harvest forearm perception using a questionnaire that contained two statements regarding pain and numbness in those 94 patients. The incidences of the harvest-site hematoma and infection were also compared between both the arms and legs where the grafts were harvested.Results Numbness of the harvest site was indicated in 26.6% (radial artery) and 33.0% (saphenous vein), respectively (P = 0.4252). Hematoma was found in 6.4% and 12.8%, respectively (P = 0.2152). On the other hand, the incidences of pain and wound infection were significantly lower in the radial artery sites (pain: 1.1% vs 23.4%, P = 0.0002; infection: 2.1% vs 11.7%, P = 0.0182).Conclusions Our early experience suggests that the use of the radial artery is safe and also demonstrates a lower incidence of harvest-site complications than saphenous vein harvesting in patients where both vessels are used as harvest sites.