导管引导下激光治疗下肢静脉曲张

目的评价导管引导下激光治疗下肢静脉曲张的可行性及有效性。方法 2011年8月—2012年8月收治30例(33条下肢)原发性下肢静脉曲张患者,在导管引导下施行激光治疗。术后随访4～16个月,平均随访(8.20±3.77)个月,观察疗效及术后并发症。结果全部患者都成功耐受激光腔内治疗,单肢时间(45.0±15.4)min。术后住院时间(3.17±0.87)d。随访时患肢沉重感、皮肤色素沉着和湿疹样改变、皮肤溃疡显著减轻或消失,无静脉曲张复发或残留。结论导管引导下激光治疗大隐静脉曲张安全可行、疗效满意、具有恢复快和瘢痕小的优点。     

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。     

激光治疗下肢浅静脉曲张术后复发的原因及防治

目的 探讨腔内激光治疗下肢浅静脉曲张术后复发的因素及防治方法.方法 回顾性分析我院从2002年10月至2006年8月激光治疗下肢静脉曲张患者453例(535条肢体),其中术后复发42例(44条肢体),复发率为8.22%.复发原因分别是:20条肢体为小腿交通静脉功能不全,15条肢体为大隐静脉主干再通,6条肢体为小隐静脉主干未处理,2条肢体为下肢深静脉瓣膜功能不全,1条肢体为双大隐静脉畸形.结果 针对42例患者不同的复发原因,采取手术治疗,分别随访1～4年无复发.结论 根据下肢静脉曲张程度和病因采取针对性手术,重视交通静脉的处理和过度扩张大隐静脉的高位结扎,是预防术后复发的关键.     

下肢静脉曲张的介入治疗

下肢静脉曲张是一种常见病。可通过静脉内射频、激光血管消融术或血管硬化术等介入治疗的方法消融大隐静脉，以达到“剥脱”曲张静脉的目的，该方法具有损伤小、痛苦少、恢复快、复发率低的特点。     

MEBO联合激光治疗下肢静脉曲张性溃疡

目的：探索下肢静脉曲张诱发下肢皮肤溃疡的治疗方法。方法：局部采用湿润烧伤膏（MEBO）包扎方法，共60例。结果：MEBO＋激光治愈55例，MEBO＋激光＋皮片移植治愈5例，治愈率100％。结论：MEBO联合激光治疗下肢静脉曲张诱发溃疡安全易行，疗效满意。     

两种波长激光治疗原发性下肢静脉曲张性溃疡的临床疗效比较

目的观察半导体激光和He-Ne激光在相同剂量条件下局部照射治疗原发性下肢静脉曲张性皮肤溃疡的临床疗效。方法选择原发性下肢静脉曲张性皮肤溃疡患者96例,随机分为半导体激光组和He-Ne激光组,每组患者48例。两组均扩束照射,能量密度均为2.4 J/cm^2,每日1次。治愈患者随访1-3年,统计复发情况。结果两组治疗结果比较,差异无显著意义（P〉0.05）;溃疡面积组内比较,差异无显著意义（均P〉0.05）;组间比较,溃疡面积〉10 cm^2者,半导体激光组疗效好于He-Ne激光组（P〈0.05）,〈5 cm^2和5-10 cm^2者,差异均无显著意义（均P〉0.05）;两组炎性反应消失及治愈天数比较,半导体激光组明显短于He-Ne激光组,差异具有显著意义（均P〈0.05）;两组溃疡复发情况比较,差异无显著意义（P〉0.05）。结论半导体激光和He-Ne激光局部照射治疗原发性下肢静脉曲张性皮肤溃疡均有较好疗效。     

下肢静脉曲张激光治疗前后血管内皮细胞功能的变化

目的探讨下肢静脉曲张激光治疗前后血管内皮细胞功能的变化。方法下肢静脉曲张患者52例,均接受激光微创治疗,同时选择52例同期、同龄、同性别健康查体者作为对照。分别抽取空腹静脉血制备相关标本,利用放射免疫和Griess方法测定血浆内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO),利用密度梯度法测定血液循环血管内皮细胞计数(circulating endothelial counting,CEC),同时测定手术后临床治愈后2周血CEC、ET-1和NO水平。结果 52例患者血浆ET-1水平和血中CEC水平均高于正常对照组(P<0.05),而NO水平则低于正常对照组(P<0.05)。术后2周其血浆ET-1水平、血中CEC水平和NO水平恢复正常或接近正常水平。结论下肢静脉曲张患者存在血管内皮细胞的损伤,激光术前和术后检测外周血CEC、ET-1和NO值的改变,有助于临床疗效的判定。     

下肢静脉曲张激光治疗前后血管内皮细胞功能的变化

目的：探讨下肢静脉曲张激光治疗前后血管内皮细胞功能的变化。 方法：选择下肢静脉曲张患者52例,均接受激光微创治疗,同时选择52例同期同龄同性别健康查体者,分别抽取空腹静脉血,制备相关标本,利用放射免疫和Griss方法测定血浆内皮素-1（ET-1）、     

湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡疗效观察

目的观察湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡的临床疗效。方法选取2016年5月至2018年6月广西壮族自治区江滨医院普外科收治的60例下肢静脉曲张性溃疡患者作为研究对象,并按照随机数表法将其随机分为观察组(30例)与对照组(30例),其中观察组患者于大隐静脉腔内激光术后采用湿润烧伤膏治疗溃疡创面,对照组患者于大隐静脉腔内激光术后采用碘伏消毒治疗溃疡创面,对比观察两组患者治疗第7天时的创面肉芽组织生长率及住院时间。结果观察组患者治疗第7天时的肉芽组织生长率为(0.425±0.084)%、住院时间为(12.30±3. 42) d,对照组患者治疗第7天时的肉芽组织生长率为(0.368±0.106)%、住院时间为(15. 94±5.46) d,两组患者肉芽组织生长率及住院时间对比,P均0.05,差异具有统计学意义。结论湿润烧伤膏联合大隐静脉腔内激光治疗下肢静脉曲张性溃疡,可明显促进创面肉芽组织生长,缩短住院时间,疗效显著,值得临床推广应用。     

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.     

静脉腔内激光术结合高位结扎治疗下肢静脉曲张的疗效评价

目的评价静脉腔内激光术结合高位结扎治疗下肢静脉曲张的疗效。方法下肢静脉曲张患者46例,男性28例,女性18例,共66条患肢接受腔内激光治疗结合高位结扎术。结果随访2~12个月,所有患者均恢复正常生活或工作,无一例复发。结论大隐静脉曲张腔内激光治疗结合高位结扎术相较静脉腔内激光术安全性更高,扩大了手术适应范围,具有微创,美观,安全,操作简单的特点。     

腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全的疗效评价

目的评价腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全的疗效。方法下肢浅静脉曲张患者64例75条肢体,根据术前股浅静脉第一对瓣膜反流时间长短分为轻度反流(40条)、重度反流两组(35条)。所有病例均采用浅静脉腔内激光处理联合大隐静脉高位结扎治疗。比较术前与术后4～6个月的反流时间,以临床-病因-解剖-病理生理(clinical-etiological-anatomical-pathophysiological,CEAP)修正法临床症状评分法评价治疗效果。结果术后反流时间的变化:轻度反流组术后反流时间小于0.5s者26例,治愈率65.0%,好转11例,总有效率92.5%。重度反流组术后反流时间小于0.5s者7例,治愈率20.0%,有效24例,总有效率88.5%,无效4例。所有病例临床症状评分均明显下降。结论腔内激光处理联合大隐静脉高位结扎治疗下肢深静脉功能不全疗效确切,但对于深静脉重度反流者应加行深静脉重建手术。     

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。     

Lower Energy Endovenous Laser Ablation of the Great Saphenous Vein with 980 nm Diode Laser in Continuous Mode

Purpose To assess clinical outcomes, complication rates, and unit energy applied using 980 nm diode endovenous laser treatment at 11 watts for symptomatic great saphenous vein (GSV) incompetence and reflux disease. Methods Thirty-four consecutive ablation therapies with a 980 nm diode endovenous laser at 11 watts were studied. The diagnosis of GSV incompetence with reflux was made by clinical evaluation and duplex Doppler examinations. The treated GSVs had a mean diameter of 1.19 cm (range 0.5–2.2 cm). The patients were followed with clinical evaluation and color flow duplex studies up to 18.5 months (mean 12.19 months ± 4.18). Results Using 980 nm diode endovenous laser ablation in continuous mode, 100% technical success was noted. The mean length of GSVs treated was 33.82 cm (range 15–45 cm). The mean energy applied during the treatment was 1,155.81 joules (J) ± 239.50 (range 545.40–1620 J) for a mean treatment duration of 90.77 sec ± 21.77. The average laser fiber withdrawal speed was 0.35 cm/sec ± 0.054. The mean energy applied per length of GSV was 35.16 J/cm ± 8.43. Energy fluence, calculated separately for each patient, averaged 9.82 J/cm² ± 4.97. At up to 18.5 months follow-up (mean 12.19 months), 0% recanalization was noted; 92% clinical improvement was achieved. There was no major complication. Minor complications included 1 patient with hematoma at the percutaneous venotomy site, 1 patient with thrombophlebitis on superficial tributary varices of the treated GSV, 24% ecchymoses, and 32% self-limiting hypersensitivity/tenderness/“pulling” sensation along the treatment area. One patient developed temporary paresthesia. Four endovenous laser ablation treatments (12%) were followed by adjunctive sclerotherapies for improved cosmetic results. Conclusion Endovenous laser ablation treatment of GSV using a 980 nm diode laser at 11 watts in continuous mode appears safe and effective. Mean energy applied per treated GSV length of 35.16 J/cm or mean laser fluence of 9.82 J/cm² appears adequate, resulting in 0% recanalization and low minor complication rates.     

经皮穿刺激光椎间盘减压术治疗腰椎间盘突出症的疗效及其影响因素

目的分析经皮穿刺激光椎间盘减压术治疗腰椎间盘突出症的疗效及其影响因素。方法腰椎间盘突出症患者145例,应用经皮穿刺激光椎间盘减压术治疗,分别于术后7 d、3和12个月评定疗效。结果术后7 d、3和12个月的优良率分别为89.6%、92.4%和93.1%;17～40岁患者疗效明显优于40～60岁患者,而以61岁以上患者优良率最低;L3/L4、L4/L5和L5/S1椎间盘高度指数,术前分别为0.35±0.14、0.41±0.09和0.38±0.05,术后12个月分别为0.33±0.08、0.39±0.11和0.36±0.07,手术前后相比差异无显著意义。结论经皮激光气化减压术治疗椎间盘突出症近期和远期疗效良好,并发症少,不影响脊柱稳定性。术后时间及患者年龄是影响疗效的因素。     

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

Objective

To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.

Materials and Methods

From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.

Results

A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.

Conclusion

Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.     

Q-开关红宝石激光治疗雀斑疗效观察

目的 观察Q-开关红宝石激光治疗面部雀斑的疗效.方法 采用Q-开关红宝石激光治疗雀斑患者206例,半年至1年随访.根据患者肤色、皮损的大小、颜色、部位、局部组织反应,调整激光治疗参数.参数范围:光斑直径3.5～5.0 mm,能量密度3.6～8.0 J/cm2,频率1 Hz.结果 一次治疗痊愈170例,二次治愈36例,一次治愈率82.5%,总治愈率100.0%.无一例发生色素脱失和瘢痕.结论 Q-开关红宝石激光治疗亚洲人皮肤雀斑有效且安全.