腔内激光联合传统手术治疗单纯下肢静脉曲张的疗效观察

目的：观察静脉腔内激光（Endovenous laser treatment，EVLT）联合传统手术治疗单纯下肢静脉曲张的近期疗效，总结治疗经验，减少并发症，提高远期疗效。方法回顾性分析2011年1月～2013年1月行大隐静脉高位结扎抽剥＋曲张静脉点式剥脱＋EVLT治疗下肢静脉曲张患者358例（457条患肢），观察患者术后下肢肿胀、浅静脉曲张、色素沉着及溃疡愈合等临床症状恢复情况以及远期复发率。结果该组1例因重度下肢深静脉瓣膜关闭不全行股浅静脉瓣膜戴戒术，下肢肿胀明显减轻，溃疡愈合，疗效良好；2例患者出院1个月后下肢深静脉血栓形成，经积极抗凝溶栓治疗后恢复顺利；68例患者小腿溃疡愈合；6条患肢出现皮肤灼伤；8例术后出现皮下积血积液；以上经积极对症治疗后基本缓解。远期随访全部患者无静脉曲张复发，无静脉溃疡迁延不愈，无皮肤营养性障碍等远期并发症，疗效持续，未见复发。结论 EVLT联合曲张静脉点式剥脱是一种安全、有效、实用的微创治疗方法，有望代替单纯传统手术应用于下肢静脉曲张的治疗。

Clinical Experience of Surgery Combined with Vascular Interventional in Treatment for Lower Limb Deep Vein Thrombosis

Objective To observe the short-term curative effect of treatment for simple varicose veins of low-er limbs using endovenous laser treatment （EVLT） combined with traditional surgical, and to summarize treatment experience, reduce the complications, and improve the forward curative effect. Methods 358 cases （457 limbs） of lower extremity varicose veins were analyzed in our department between January 2011 and January 2013. We used the traditional great saphenous vein high ligation and stripping operation＋veins dot stripping technique＋EVLT to treat these patients, and observed these patients postoperative of lower limb swelling, shallow varicose veins, pigmentation, ulcer healing, and long-term recurrence rate. Results 1 case of severe deep venous insufif-ciency of lower limbs accepted the wearing ring of femoral superifcial vein valve surgery, the lower limb swelling signiifcantly reduced, ulcer healing and curative effect was well. 2 patients of lower limb deep vein thrombosis restored smoothly after active anticoagulant thrombolytic therapy, 68 patients of leg ulcers healed well, 6 limbs skin were burned, 8 cases appeared subcutaneous hemorrhage effusion, but relieved basicly after symptomatic treatment. Long-term follow-up of all patients with no recurrence of varicose veins nonhealing venous ulcer and no nutritional skin disorders, the effects lasted and no recurrence. Conclusion EVLT combined varicose vein dot stripping is a safe, effective, practical and minimally invasive treatment method. It is supposed to replace the pure traditional operation used in the treatment of lower extremity varicose veins.