腔内激光联合内镜下交通支结扎治疗下肢静脉曲张186例临床分析  

Endovenous laser treatment plus subfascial endoscopic perforator surgery in managing primary varicose vein of lower extremities

作　　者：陈以宽[1] 朱仕钦[1] 罗文军[1] 孙建明[1] 沈庆明[1] 

机构地区：[1]重庆医科大学附属第二医院血管外科,重庆400010

出　　处：《第三军医大学学报》2007年第24期2370-2372,共3页Journal of Third Military Medical University

摘　　要：目的分析我院从2003年6月至2006年5月对186例下肢大隐静脉曲张合并小腿交通支瓣膜功能不全患者分别行腔内激光治疗（endovenous laser treatment，EVLT）或联合内镜下交通支结扎（subfascial endoscopic perforator surgery，SEPS）的治疗效果。方法所有患者均行顺行性静脉造影确诊，超声多普勒检查确定无深静脉、小隐静脉瓣膜功能不全。按随机数字表法将患者分为EVLT组98例，EVLT＋SEPS组88例。两组临床资料无显著性差异。随访3～32个月。结果治疗后两组患者曲张静脉消失满意，在胀痛感、皮肤瘙痒、内踝区水肿缓解方面没有显著性差异，溃疡均愈合，但对于溃疡患者，EVLT＋SEPS组在溃疡愈合时间、术后住院时间、溃疡复发上优于EVLT组。结论有小腿交通支瓣膜功能不全的大隐静脉曲张患者，无溃疡形成时，可只行浅静脉手术；当有溃疡形成时，应同时行浅静脉手术和小腿交通支结扎手术。EVLT是治疗浅静脉曲张的安全、有效措施，EVLT联合SEPS是治疗下肢静脉曲张合并溃疡时的理想选择。Objective To retrospectively analyze the therapeutic effects of endovenous laser treatment （EVLT） or combined with subfascial endoscopic perforator surgery （SEPS） for varicose great saphenous vein and calf incompetent perforator vein. Methods The diagnosis was confirmed by ascending venography. Ultrasound scanning was used to exclude incompetent small saphenous vein and deep vein. From June 2003 to May 2006, 186 patients were randomly assigned to undergo EVLT （n = 98） and EVLT ＋ SEPS （n = 88）. The clinical and demographic data of two groups showed no significant difference. The duration of follow-up varied from 3 to 32 months. Results After treatment, the varicose veins of two groups were relieved completely, without significant difference in relief of pain, edema or itching. The ulcers all healed, yet the healing time of ulceration, postoperative hospital stay and recurrence rate of ulcers in the patients receiving EVLT ＋ SEPS were less than that by EVLT. Conclusion For the patients who had varicose great saphenous vein and calf incompetent perforator vein, but without ulceration, surgery for superficial veins alone is appropriate. However, for those with ulceration, surgery for superficial vein and incompetent perforator vein is definitely needed. EVLT is safe and effective in the treatment of varicose superficial vein, and EVLT ＋ SEPS is a good choice in managing varicose vein of lower extremity with ulceration.

关 键 词：腔内激光治疗 内镜下交通支结扎 原发性大隐静脉曲张 交通支瓣膜功能不全 

分 类 号：R454.2[医药卫生—治疗学] R543.605[医药卫生—临床医学]