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。

Endovenous Laser Treatment Combined with Operation for Varicose Veins of Lower Extremity

Objective To assess the safety and efficacy of endovenous laser treatment (EVLT), a novel technique for occlusion of the incompetent great saphenous vein(GSV), and explore the methods preventing complications. Methods Two hundred and thirty five GSVs (from 198 patients) with reflux at the saphenofemoral junction were treated endovenously with pulses of laser energy combining with operations respectively, which including ligation of GSVs (LGSV, 162 GSVs ),first valve repair of superficial femoral vein and LGSV (45 GSVs),and perforators ligation and LGSV and/or first valve repair of superficial femoral vein (28 GSVs), and evaluated in a prospective, nonrandomized, consecutive enrollment study. Patients were followed by ultrasonography at 2 weeks and at 1, 3, 6, and 9 months. Results All of 235 GSVs (100%) were obstructed 2 weeks after initial treatment with endovenous laser. There were 5 cases with local anesthetized feeling pain during EVLT , and the pain relieved after decreasing the laser power. Venous varicose,small branches of GSV in the legs were found in six cases during 1-2 months after the initial operation,which might be missed in the operation, and were obstructed after repeated treatment. The main complications included hematoma(7 cases), skin burned (18 cases)and transient localized skin paresthesia(6 cases). All the 235 GSVs (100%) remained obstruction for as long as 28 months according to serial duplex ultrasonography. Conclusions EVLT of the incompetent GSVs combining with operation appears to be an safe,effective, and less injurous technique that yields impressive short-term results.