激光光凝技术结合静脉瓣膜修复治疗下肢深静脉瓣膜功能不全的手术探讨

目的探讨股浅静脉瓣窦环包联合激光光凝技术治疗下肢深静脉瓣膜功能不全的手术治疗方法. 方法 33例下肢深静脉瓣膜功能不全的患者,在硬膜外麻醉下首先在卵圆窝下方4 cm做长约4 cm小切口,行股浅静脉瓣膜外修复,同时高位结扎切断大隐静脉,再由大隐静脉远端插入4F导管,光导纤维跟入,使用810 nm波长的半导体激光器,对下肢迂曲扩张的大隐静脉及其浅静脉进行血管内光凝术. 结果术后6 h即可自由活动,术后8 d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.平均随访18(6～24)个月,超声检查示大隐静脉和曲张浅静脉均已闭合、深静脉瓣膜外修复处均无返流,无复发或再通现象,局部皮肤营养障碍性病变明显减轻,下肢酸胀感减轻或消失. 结论激光光凝技术结合静脉瓣膜修复治疗下肢深静脉瓣膜功能不全,方法可行、疗效可靠、操作简便、创伤小、美观、恢复快,是一种较好的微创治疗方法,值得推广应用.

Laser Photocoagulation and Valve Repair Operations for Primary Deep Venous Valve Dysfunction

Objective To assess the effect of combined application of valve repair operation and laser photocoagulation in patients with primary deep venous valve dysfunction. Methods Thirty-three patients with primary deep venous valve dysfunction were selected. The 4 cm incision was made and valve repair operations were performed. The laser wire was deliverd into saphenous vein through 4F conductor, the intravenous photocoagulation was made with 810 nm laser wave length. Results The limbs returned to unlimited movement at 6 hours postoperatively, and all stitches removed 8 days postoperatively with well-healed incision. No burns of skin, subcutaneous hematoma and edema of lower limb occured postoperatively. With 6 to 24 month(averagely 18 months) followed-up, the great saphenous vein and varicose vein were identified occlusion and the repaired valves never develop any reflux. The local skin malnutrition atrophy recovered gradually and the venous varicosis disappeared completely. Conclusion The integration of laser photocoagulation and valve repair operations demonstrate the advantages of conveniece, minimal invasion, and rapid recovery, which should be recommeded as a minimal invasive procedure for patients with primary deep venous valve dysfunction.