静脉腔内激光闭合术治疗原发性下肢静脉曲张效果分析

目的 探讨静脉腔内激光闭合(EVLT)术治疗原发性下肢静脉曲张(PLEVV)的效果。方法 回顾性分析商城县伏山乡卫生院外科2019-06—2021-06收治的82例PLEVV患者的临床资料。分为皮下静脉曲张透光旋切术(TriVex)组和EVLT组,各41例。比较2组患者的围术期指标。术前、术后6个月,采用慢性静脉功能不全问卷评分(CIVIQ-20)评价2组患者的生活质量。结果 EVLT组的手术时间、住院时间均短于TriVex组,差异有统计学意义(P<0.05)。术后随访6个月期间2组患者的并发症发生率差异无统计学意义(P>0.05)。术后6个月时2组患者的CIVIQ-20评分均较术前显著改善,其中EVLT组患者的改善效果优于TriVex组,差异均有统计学意义(P<0.05)。结论 EVLT术和TriVex术治疗PLEVV患者均有良好的效果和安全性,其中EVLT术具有手术时间和住院时间短、患者术后生活质量高等优势。     

激光腔内闭合治疗下肢静脉性溃疡

目的 探讨激光腔内闭合术在治疗下肢静脉性溃疡中的价值.方法 20例下肢慢性静脉功能不全合并下肢静脉性溃疡患者采用10～16 W激光腔内闭合治疗,术后定期随访效果.结果 无皮肤灼伤等并发症出现,术后浅静脉曲张均消失,大部分溃疡于术后2～4周内愈合,最长随访18个月,无溃疡复发.结论 腔内激光闭合术创伤小、安全性高、效果确...     

腔内激光闭合术联合点状切口穿通支离断术治疗下肢静脉性溃疡

慢性静脉功能不全（chronic venous insufficiency，CVI）所致的下肢静脉性溃疡临床常见，但治疗困难。穿通支静脉瓣膜功能不全引起的下肢静脉高压，是静脉性溃疡发生的主要原因。本研究采用腔内激光闭合术联合点状切口穿通支离断术治疗下肢静脉性溃疡24例，报道如下。     

腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗下肢静脉性溃疡的疗效观察

目的 探讨腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗下肢静脉性溃疡(VLU)的疗效.方法 收集2016年1月至2018年1月巴彦淖尔市医院治疗的180例VLU患者临床资料.根据治疗方式不同分为腔内激光闭合术联合超声引导下泡沫硬化剂注射治疗作为激光组(n=90);大隐静脉曲张高位结扎联合超声引导下泡沫硬化剂注射治疗作...     

复方黄柏液联合腔内激光闭合术治疗下肢静脉性溃疡的临床疗效分析

目的:探讨复方黄柏液联合腔内激光闭合术治疗下肢静脉性溃疡的临床疗效。方法:回顾性分析2020年9月—2021年7月我科收治的58例下肢静脉性溃疡患者,分为三组:腔内激光闭合术+压力治疗归为A组(20例),复方黄柏液+压力治疗归为B组(19例),复方黄柏液+腔内激光闭合术+压力治疗归为C组(19例),收集并分析三组患者术后1个月的临床疗效、预定观察时间的溃疡面积缩小率以及VAS疼痛评分、住院时间等资料。结果:三组患者一般资料比较无统计学意义(P＞0.05),具有可比性。三组患者1个月内溃疡临床疗效比较差异有统计学意义(P＜0.05)。第1、2、3、4周末,C组溃疡面积缩小率明显高于A、B组,差异有统计学意义(P＜0.05)。C组患者住院时间明显少于A组和B组,差异有统计学意义(P＜0.05);三组患者治疗前VAS疼痛评分差异无统计学意义(P＞0.05),具有可比性;第4周末,三组患者VAS疼痛评分差异有统计学意义(P＜0.001),C组患者VAS疼痛评分明显低于A组和B组,差异有统计学意义(P<0.05)。结论:复方黄柏液联合腔内激光闭合术治疗下肢静脉性溃疡,既能去除病因,又能祛邪扶正、祛腐生肌、抑菌抗炎,可明显缩短溃疡愈合时间,显著改善临床症状。     

腔内激光消融术治疗下肢静脉性溃疡临床分析

目的探讨腔内激光消融术(EVLA)治疗下肢静脉性溃疡(VULE)的疗效和安全性。方法 32例(36条患肢,42处溃疡)VULE患者,均行大隐静脉高位结扎+EVLA闭合曲张浅静脉及溃疡床周围穿通支静脉,术后穿循序弹力袜(20~30 mmHg)。结果手术时间30~90 min,平均50min;术中出血量2~20 ml,平均10 rnl;术后住院时间3~10 d,平均5 d。术后随访6~24个月,溃疡愈合率为90%(38/42),平均愈合时间为28 d(14~45 d),2年内累积溃疡复发率为7.9%(3/38)。患者生活质量较术前明显改善,无严重并发症。结论 EVLA能有效治疗VULE,具有损伤小、并发症少、安全性高、溃疡复发率低等优点。     

微波静脉腔内闭合术治疗下肢浅静脉曲张

我院2007年9月-2009年7月采用微波静脉腔内闭合技术治疗下肢浅静脉曲张88例（105肢）,取得较好的疗效,报道如下。     

评价腔内激光闭合术治疗原发性下肢静脉曲张的效果

目的评价腔内激光闭合术治疗原发性下肢静脉曲张的效果。方法随机将2017-06—2018-01间郑州大学第二附属医院血管外科收治的50例原发性下肢静脉曲张患者分为2组。对照组(24例)行大隐静脉高位结扎+主干与曲张静脉分段剥脱术;观察组(26例)实施腔内激光闭合术。比较2组的疗效。结果观察组的治疗总有效率、踝围改善效果及皮下渗血灶面积、小腿隐神经受损导致的局部皮肤异常感觉发生率,均优于对照组,差异均有统计学意义(P0.05)。结论腔内激光闭合术治疗原发性下肢静脉曲张,可明显改善患者踝围、减少术后并发症发生率,临床疗效显著。     

手术联合激光腔内闭合治疗下肢静脉曲张

目的探讨手术联合激光腔内闭合治疗下肢静脉曲张的临床疗效。方法笔者所在医院2009年1月～2011年1月选用北京产半导体激光治疗机对180例大隐静脉曲张患者（258条肢体）采用手术联合腔内激光技术治疗。结果随访2—4个月,270条肢体曲张的静脉全部消失,25条肢体皮肤色素沉着消失或明显减淡。4例大面积溃疡患者溃疡完全愈合。隐神经损伤3例,皮肤烧灼伤15例,曲张静脉残留2例。结论手术联合腔内闭合术治疗下肢静脉曲张疗效好、创伤小、复发率低、并发症少。     

煨脓长肉膏联合浅静脉腔内激光术治疗臁疮

目的：评价煨脓长肉膏联合浅静脉腔内激光术治疗臁疮的疗效。方法：将72例患者随机分为治疗组和对照组。治疗组用煨脓长肉膏联合浅静脉腔内激光术治疗,对照组采用康复新液换药联合浅静脉腔内激光术治疗。结果：治疗组治愈31例,好转4例,无效1例,总有效率为97.2%;对照组治愈20例,好转11例,无效5例,总有效率为86.1%（P〈0.05）。治疗组和对照组的疮面愈合时间均数分别为（16.39±7.42）d和（55.70±31.37）d（P〈0.01）。症候群改善只有瘙痒、疼痛症候有统计学意义（P〈0.05）。结论：煨脓长肉膏联合浅静脉腔内激光术治疗臁疮,可以提高治愈率,缩短疗程,改善症状。     

Heat conduction from the exceedingly hot fiber tip contributes to the endovenous laser ablation of varicose veins

Lower-extremity venous insufficiency is a common condition, associated with considerable health care costs. Endovenous laser ablation is increasingly used as therapy, but its mechanism of action is insufficiently understood. Here, direct absorption of the laser light, collapsing steam bubbles and direct fiber-wall contact have all been mentioned as contributing mechanisms. Because fiber tips have reported temperatures of 800–1,300°C during endovenous laser ablation, we sought to assess whether heat conduction from the hot tip could cause irreversible thermal injury to the venous wall. We approximated the hot fiber tip as a sphere with diameter equal to the fiber diameter, having a steady state temperature of 800°C or 1,000°C. We computed venous wall temperatures due to heat conduction from this hot sphere, varying the pullback velocity of the fiber and the diameter of the vein. Venous wall temperatures corresponding to irreversible injury resulted for a 3 mm diameter vein and pullback velocities <3 mm/s but not for 5 mm and ≥1 mm/s. The highest wall temperature corresponded to the position on the wall closest to the fiber tip, hence it moves longitudinally in parallel with the moving fiber tip. We concluded that heat conduction from the hot fiber tip is a contributing mechanism in endovenous laser ablation. An erratum to this article can be found at     

Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips

Open in a separate window OBJECTIVESWe evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits.METHODSA total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge.RESULTSThere was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55).CONCLUSIONSVaricose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.     

Comparison of tumescent versus ultrasound guided femoral and obturator nerve blocks for treatment of varicose veins by endovenous laser ablation

BackgroundEndovenous laser ablation (EVLA) is a new method for treating greater saphenous vein insufficiency. Most of physicians use local anesthesia for needle punctures and tumescent anesthesia (TA) to prevent pain and protects the surrounding tissues from the conduction of heat that would originate from the effects of laser energy on the venous wall. The aim of this study is to compare the use of local tumescent anesthesia alone or combined with ultrasound guided femoral and obturator nerve blocks for treatment of varicose veins by endovenous laser ablation.MethodologyThis is a randomized, double blind study included 80 patients scheduled for endovenous laser ablation for varicose veins of the great saphenous vein (GSV) located in the anterior or medial aspect of the leg were prospectively divided into two groups of 40 patients each. Group (A) had EVLA using tumescent anesthesia given by the surgeon. Group (B) had femoral and obturator nerves block before tumescent anesthesia was done. Intraoperative pain associated with applying the tumescent anesthesia and during performing ablation was measured using visual analogue scale. Volume of tumescent was compared in both groups. After finishing the operation, femoral and obturator motor block were evaluated. Postoperative VAS, time of stay in recovery area, patient and doctor satisfaction were also measured.ResultsPain on application of tumescent anesthesia and during surgery revealed that group (A) had more intense pain than group (B). Volume of tumescent used during surgery; group (B) used statistically significant less tumescent solution than group (A). Motor block was measured after finishing the operation, 100% of group (A) had no restriction to active movements while 2.5%, 80% and 7.5% had no restriction, mild restriction and moderate restriction to active movements, respectively in group (B). Group (A) had more pain than group (B) postoperatively. Duration of post procedure stay in recovery area showed no statistically significant difference between the two studied groups. Patients and doctors satisfaction was significantly higher in group (B) in comparison to group (A).ConclusionUltrasound guided femoral and obturator nerve blocks combined with tumescent anesthesia are effective methods of anesthesia during endovenous laser ablation than using tumescent anesthesia alone.     

腔内激光和微波治疗下肢慢性静脉功能不全的临床研究

目的探讨血管腔内激光和血管腔内微波治疗下肢慢性静脉功能不全的效果。方法将196例CEAP分期C3～C6级患者随机分为激光治疗组(EVLT组,102例)和微波治疗组(EMT组,94例),分别行血管腔内激光治疗和血管腔内微波治疗。对比两组患者术后恢复情况、并发症及血管病理学改变。结果两组患者症状均明显改善,皮肤灼伤、皮肤麻木、硬性条索、术后复发残留、术后症状改善情况及两组血管治疗后病理改变均无统计学差异(P0.05),EVLT组患者皮下淤血发生率(25.5%)稍高于EMT组(14.6%)(P0.05)。结论血管腔内激光与血管腔内微波均可有效治疗下肢慢性静脉功能不全,近期效果均满意。但长期疗效有待进一步观察。     

内镜深筋膜下穿通静脉离断联合腔内激光治疗下肢静脉曲张

目的: 探讨内镜深筋膜下穿通静脉离断术（subfascial endoscopic perforator surgery, SEPS）联合腔内激光治疗（endovenous laser treatment,EVLT）术治疗下肢静脉曲张的可行性。方法: 2016年8月至2017年10月,静脉顺行造影诊断下肢穿通静脉瓣膜功能不全患肢81条,选择40条患肢行SEPS术,联合EVLT术闭合浅表曲张静脉,保留健康大隐静脉作为研究组;41条患肢作为对照组,行传统大隐静脉高位结扎抽剥术。结果: 研究组曲张静脉团块消失,下肢静脉血淤滞得到缓解,色素沉着减轻,溃疡愈合,随访5~11个月无复发。研究组手术时间少于对照组（1.1 h比3.0 h）,切口数也少于对照组（2.1个比5.8个）,住院时间缩短（1.1 d比3.9 d）,下肢淤斑面积减少（5.2 cm³比20.3 cm³）,差异均有显著统计学意义（P<0.01）。结论: SEPS联合EVLT术适合个体化微创治疗下肢静脉曲张,创伤小、恢复快。     

Tumour ablation by laser in general surgery

More surgeons are becoming interested in laser surgery, but, in laser tumour ablation the real improvement in open surgery can only be provided by:

Noncontact tissue ablation by holmium:YSGG laser pulses in blood

To assess the feasibility of intra-arterial tissue ablation by Holmium:YSGG laser pulses (2.1 microns) in a noncontact mode, the transmission of the laser pulses through saline and blood was measured. The temporal interaction between the 500 microseconds laser pulse and saline at the fiber tip was investigated with time-resolved flash photography. The penetration depth in blood, and saline depended on the fiber output energy. In blood at 37 degrees C, the penetration depth varied from 1.2 to 2.1 mm for intensities of 3.1 to 12.4 J/mm2 per pulse, respectively, whereas its theoretical value for water is 0.33 mm, which is based on the measured absorption coefficient of 3.0 +/- 0.1/mm. The large penetration depth was due to the development of a transparent vapour cavity around the fiber tip. In saline, its maximum length was 4.7 mm. Its maximum width was 2.8 mm. The lifetime of the cavity was 450 microseconds. In blood, ablation of porcine aorta was feasible at a distance of 3 mm. Large fissures observed in adjacent tissue are likely to be caused by the expansion of the vapour cavity. We conclude that, due to a "Moses effect in the microsecond region," Holmium:YSGG tissue ablation is possible through at least 2.7 mm of blood.     

Intestinal complications after antenatal fetoscopic laser ablation in twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome (TTTS) occurs in 9% of monochorionic twin pregnancies. An imbalanced blood flow across placental vascular communications produces a hypovolemic condition in the donor fetus and hypervolemia in the recipient fetus, leading to a variety of postnatal complications. We report 3 cases of intestinal injury in TTTS after fetoscopic laser ablation of the communicating vessels: 2 cases of intestinal atresia, and 1 case of necrotizing enterocolitis of 1 twin. Intestinal ischemic diseases have been reported after prenatal laser treatment in TTTS; with this report, we add 3 more cases.     

透光直视旋切术与腔镜深筋膜下结扎交通支静脉在静脉性溃疡治疗中的疗效比较研究

目的比较透光直视旋切术(TriVex)与腔镜深筋膜下结扎交通支静脉(SEPS)治疗静脉溃疡的效果。方法将我院在2009年1月至2011年6月间收治的静脉溃疡患者根据住院单双号分为TriVex组和SEPS组。TriVex组行大隐静脉高位结扎、抽剥和TriVex静脉旋切系统旋切术,对溃疡周围浅静脉予完全刨除;SEPS组行大隐静脉高位结扎、抽剥和腔镜深筋膜下结扎交通支静脉,对小腿曲张静脉及溃疡周围静脉行点状抽剥术。比较两组患者在溃疡愈合率、愈合时间及术后溃疡复发率的差异。结果两组患者的溃疡愈合率、愈合时间及溃疡复发率比较,差异无统计学意义(P>0.05),且均未发生深静脉血栓形成等严重并发症,但SEPS组术后皮下淤血或局部皮肤麻木感等轻微并发症高于TriVex组,而患者满意率低于TriVex组,两组差异有统计学意义(P<0.05)。结论 TriVex和SEPS均可有效治疗静脉溃疡,但SEPS可能会出现更多的皮下淤血或局部皮肤麻木感等轻微并发症,患者对TriVex的满意度更高。