激光闭合联合动力旋切治疗下肢静脉曲张

目的探讨激光闭合联合动力旋切治疗下肢静脉曲张的效果和安全性。方法将351例下肢静脉曲张病人随机分组：A组111例，用激光行大隐静脉全程原位闭合，小腿曲张静脉用透光动力旋切；B组106例，用激光行大隐静脉大腿段原位闭合。小腿曲张静脉用透光动力旋切；C组134例，传统手术作对照，大隐静脉高位结扎、抽剥，属支及交通支切除、结扎。观察术后效果和并发症的情况。结果所有病人下肢肿胀、酸痛、乏力在手术后1个月逐步消失；皮肤色素沉着在术后1个月减轻，3月逐步恢复。传统手术没有皮肤烧灼发生，但其并发症多，如小腿皮肤麻木、大腿瘀斑、创口血肿以及踝以下肿胀。比较A、B组之间无统计学差异，分别与C组均有统计学差异，传统手术组明显增多。小腿瘀斑，A组与C组比较均有统计学差异，B组与C组比较均无统计学差异。全部病例无下肢深静脉血栓形成和切口感染。结论激光闭合联合动力旋切治疗下肢静脉曲张，简单可行，疗效确切；动力旋切去除静脉团效果好，不适用旋切大隐静脉主干。

Combination use of Laser and transilluminated powered phlebectomy in treatment of varicose veins of lower extremity

Objective To evaluate the efficiency and safety of treatment of varicose veins of lower extremity by combination use of laser and transilluminated powered phtebectomy. Methods 351 cases were randomly divided into three groups： group A （111 cases） -endovenouser whole range closure in situ for great saphenous vein by laser plus transilluminated powered phlebectomy for varicose veins of leg ; group B（106 cases）-endovenouser whole range clo- sure in situ for upper leg part of great saphenous vein by laser plus transilluminated powered phlebectomy for varicose veins of leg; 134 conventional treatment cases were selected as controlled group （Group C）, high ligation and strip- ping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used. Consequences and complications of operations were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness, and infirmity disappeared within one month after the operation, skin pigmentation was alleviated within one month after the operation, and disappeared gradually within three months. In group C, there were more complications but skin cauterization was less than trial groups. Comparing three groups in complications of skin numbness of legs, upper leg ecchymosis, wound hematoma, and swellings below ankle, there were no statistical differ- ences between group A and B, and there were statistical difference between group A and C, and B and C. In all cas- es, there were no deep vein thrombosis of lower extremity and incision infection. Conclusion It is simple, and effi- cient to use combination of laser and transilluminated powered phlebectomy in treatment of varicose veins of lower ex- tremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.