腔内激光治疗大隐静脉曲张192例报告

目的 探讨腔内激光治疗大隐静脉曲张的疗效。方法 2004年7月～2006年3月我院对192例238条肢体大隐静脉曲张行高位结扎、激光烧灼静脉主干和小腿曲张静脉。小腿局部严重曲张的静脉团,另做切口做局部切除或点状抽拨。结果 本组一次治愈率96.2%（229/238）。9例9条肢体术后因仍有少量曲张静脉存在,局麻下行切除或再次激光治愈。114例大隐静脉主干及小腿局部条索状硬结、疼痛;9例皮肤灼伤。术后住院时间4～8 d,平均5.6 d。158例随访1～18个月,平均11.6月,未见复发。结论 腔内激光治疗大隐静脉曲张效果确切,创伤小。     

射频闭合与传统剥脱术治疗下肢静脉曲张的对照研究

目的评价射频闭合(radiofrequency endovenous obliteration,RFO)的疗效。方法 56例(56条肢体)大隐静脉曲张患者随机分为两组,每组28例。RFO组利用射频能量使大隐静脉全程闭合,静脉剥脱组用传统方法高位结扎剥脱大隐静脉。两组病例小腿散在的曲张浅静脉均采用点式剥脱处理。比较两组病例的切口数、术后疼痛、平均住院日和短期疗效等情况。结果 RFO组平均切口少、术肢疼痛轻、无皮下血肿,术后平均住院日(2．50±1．00)d。静脉剥脱组的术后平均住院日(4．14±0．85)d。结论 RFO闭合大隐静脉具有创伤小、恢复快、腿部少留瘢痕等优点,是一种可部分替代传统大隐静脉高位结扎剥脱术的有效方法。     

Radiofrequency-induced thermotherapy (RFiTT) in a porcine liver model and ex vivo great saphenous vein

Aims: To investigate the thermal spread achieved in porcine liver when using an optimised radiofrequency ablation protocol and correlate findings with the effects seen in ex vivo great saphenous vein (GSV), in order to justify clinical use with the new treatment protocol.

Material and methods: Porcine liver and GSV sections were treated with radiofrequency-induced thermotherapy (RFiTT) using the following settings: 20 W at 1?s/cm (linear endovenous energy density; LEED 20 J/cm), 18 W at 1?s/cm (LEED 18 J/cm), 18 W at 3?s/cm (LEED 54 J/cm), 6 W interrupted pull-back 6?s stationary every 0.5?cm (LEED 72 J/cm). Thermal spread in the liver was measured via digital imaging. GSV sections were sent to an independent laboratory for histological analysis. Previous work suggests a thermal spread of?>0.65?mm in liver correlates with transmural thermoablation of a GSV.

Results: Parameters giving a LEED of 72 J/cm produced the best results, with a clear transmural effect in the GSV and maximal thermal spread of 1.65?mm, without excessive thermal damage or carbonisation in the ablation tract.

Conclusions: Our porcine liver model correlated well with histological findings and was representative of the thermoablative effects observed in the GSV wall treated with RFiTT. Clinical investigations are now being carried out to investigate the efficacy of this protocol in the clinical setting.     

超声引导下隐筋膜间隙肿胀液麻醉在大隐静脉激光闭合术中的应用

目的探讨超声引导下隐筋膜间隙肿胀液麻醉在大隐静脉激光闭合术中的应用价值。方法选取行大隐静脉激光闭合术的患者60例,按随机数字表法分为观察组和对照组,每组30例,观察组在超声引导下分段穿刺隐筋膜间隙注入肿胀麻醉液配合芬太尼静脉清醒镇痛,对照组给予传统的腰麻,观察两组麻醉效果。结果两组阻滞起始时间和阻滞成功率比较差异均无统计学意义。麻醉后5 min阻滞感觉评分观察组高于对照组,差异有统计学意义(P0.05),麻醉后15 min、25 min及30 min两组阻滞感觉评分差异均无统计学意义;观察组手术开始即刻心率高于对照组,差异有统计学意义(P0.05),术前、术后15 min及术后30 min心率和平均动脉压两组间比较差异均无统计学意义;术后麻醉恢复即刻与术后2 h视觉模拟评分比较差异均无统计学意义,观察组术后4 h、6 h及8 h视觉模拟评分均低于对照组,差异均有统计学意义(均P0.05),观察组和对照组术后6 h视觉模拟评分均最高,8 h后降低,差异均有统计学意义(均P0.05)。结论超声引导下隐筋膜间隙肿胀液麻醉应用于大隐静脉激光闭合术加散在曲张静脉点式剥脱术中,安全、可靠、方便,尤其适合于单纯大隐静脉曲张患者,具有较好的临床应用价值。     

大隐静脉曲张微创治疗进展

大隐静脉曲张(GSVV)是一张常见疾病,主要表现为下肢浅静脉迂曲扩张,常合并溃疡、湿疹、静脉炎等。由于静脉血液动力学改变,使静脉主干和皮肤毛细血管压力增高, 导致皮肤皮下缺血缺氧和营养缺乏, 皮肤色素沉着、 纤维化、 皮下脂肪硬化、 皮肤萎缩, 最终形成静脉性溃疡;随着医疗技术的发展,各种微创治疗方式应用于GSVV,该文就GSVV治疗现状予以综述。     

Recognition and Management of Venous Leg Ulcers

The management of venous leg ulcers can pose quite a challenge to patients and health care providers. This condition can significantly impact quality of life and impose a huge financial burden on the patient and health care system. This review article will discuss the importance of early recognition of high-risk patients, with evaluation and initiation of appropriate multimodality treatment, which must be done in a timely and efficient manner.     

Endovenous and perivenous 808-nm laser treatment of lower limb collateral,reticular and telangiectasiac veins

Background: Visible leg veins are not only a mere aesthetic problem, but may also be manifestation of altered microcirculation and superficial venous incompetency. Sclerotherapy is the first-line treatment for leg veins < 4 mm, but it often needs multiple sessions and sometimes fails. The main limitations of transcutaneous laser treatment are the diameter and the depth of the veins: the greater, the harder photothermolysis is, so that higher powers may lead to aesthetic complications. Materials and methods: We report our experience in the treatment of small collateral (< 4 mm), reticular and telangiectasiac veins with endovenous and perivenous 808-nm laser. Results: Overall, 325 treatments were performed on 113 patients. The endovenous and perivenous treatment proved to be a safe, quick, well-tolerated and effective procedure. It ensured an optimal closure of the target veins right from the first treatment in most patients. Sometimes, a second treatment of the same vein was needed. Conclusions: The endovenous and perivenous 808-nm laser photothermal sclerosis ensures a quick coagulation-fibrosis of the veins of the lower limbs, thus allowing rapid healing and good aesthetic results (stable in 95% of patients after an average follow-up of 18 months). It may be an effective alternative to sclerotherapy.     

腔内射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全

目的 评价腔内射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全的疗效.方法 150例下肢静脉功能不全患者(150条患肢)随机分为A、B两组,每组75例.A组行大隐静脉射频闭合术联合曲张浅静脉TriVex刨吸术,B组行大隐静脉高位结扎抽剥术联合曲张浅静脉TriVex刨吸术.比较两组的手术时间、术后首次下床时间、术后48 h的疼痛视觉模拟评分(VAPS)值、术后住院天数、皮下血肿和皮下硬结的发生情况;比较患者对手术的自身评价、手术前后美国静脉联盟CEAP分级、临床严重程度计分(VCSS)、慢性静脉功能不全问卷(CIVIQ)生活质量评分的变化.结果 两组手术时间差异不显著,A组术后疼痛轻、下床时间早、住院天数少、皮下血肿发生率低,但皮下硬结发生率高于B组;术后4周对手术的评价A组优于B组;A、B手术前后CEAP分级、VCSS、CIVIQ评分变化差别有统计学意义(P<0.05),两组间VCSS分差、CIVIQ评分差异无统计学意义(P>0.05).结论 利用射频闭合术联合TriVex刨吸术治疗下肢静脉功能不全有效,且微创、并发症少、更具人性化;CEAP临床分级、VCSS临床计分和CIVIQ生活质量评分可用于评价其疗效.     

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。     

大隐静脉曲张腔内激光治疗术后并发症原因分析及预防

目的探讨腔内激光治疗（endovenous laser treatment,EVLT）大隐静脉曲张术后并发症发生原因及防治。方法回顾我院2003年8月～2007年2月采用大隐静脉高位结扎联合EVLT治疗342例（530条肢体）大隐静脉曲张,分析术后186条肢体出现的并发症。结果随访6个月,23条肢体皮下淤血、血肿,65条肢体静脉炎反应,20条肢体皮肤烧伤,经治疗全部治愈。77条肢体隐神经损伤（皮肤感觉异常）,经治疗57条治愈,余20条好转。1例深静脉血栓形成并发肺栓塞,经治疗好转。结论EVLT术中联合大隐静脉高位结扎,根据部位适当调整激光功率,轻柔操作,术后早期活动及预防性抗凝等措施,可预防或减少并发症的发生。