透光动力旋切术治疗下肢静脉曲张的疗效分析和手术体会  

Therapeutic Effect Analysis and Operation Comprehend of Transilluminated Powered Phlebectomy for Patients with Varicose Vein of Lower Extremities

作　　者：朱远志[1] 罗军[1] 刘坤[1] 揭月高[1] 

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心,乌鲁木齐830054

出　　处：《中国普外基础与临床杂志》2010年第11期1171-1174,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨透光动力旋切术(旋切术)治疗下肢静脉曲张的疗效、手术要点及临床意义。方法我院自2006年5月至2009年11月期间收治下肢浅静脉曲张患者255例(363条患肢),其中男126例,女129例。按修订后的CEAP临床分级(clinical etiology anatomic and pathophysiological classification system),C2级104条,C3级53条,C4级155条,C5级34条,C6级17条。均采用旋切术治疗,对患者进行术后随访,观察术后并发症发生情况。结果所有患者术前标记的曲张静脉均被切除,手术时间单侧患肢(100±20)min,双侧(147±19)min。术后221例患者(302条患肢)获得随访,随访时间4～46个月,中位随访时间为24.5个月;其中术后1年以上的患者167例(247条患肢),获得随访154例(229条患肢)。随访1年以上者中11条患肢复发,2条少量细小曲张静脉残留,术后1年以上复发率为5.68%(13/229)。21条肢体溃疡于术后3～6周内愈合。术后并发症:16条肢体足踝部皮肤感觉异常或疼痛,经理疗后3～6个月明显好转;112条肢体有小腿皮肤瘀斑,于3～5周后吸收消退;37条肢体出现小腿肿胀,于1～2周消退好转;2条肢体出现局部皮下血肿,5条肢体切口轻度感染,1条肢体内踝上方皮肤和皮下组织坏死,2条肢体腘窝处皮肤损伤,均经对症处理后痊愈。结论下肢静脉曲张的手术治疗实际上是多种手术方法的联合应用,旋切术治疗下肢静脉曲张的临床初步研究表明,其具有安全、简便、美观的特点。Objective To explore the effect,operational essential,and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity.Methods In the study,255patients with 363lower extremities of varicose vein in our hospital between May 2006and November 2009were treated by transilluminated powered phlebectomy.According to revised clinical etiology anatomic and pathophysiological classification system（CEAP）,there were 104limbs in C2,53limbs in C3,155limbs in C4,34limbs in C5,and 17limbs in C6.The patients were followed up to observe postoperative complications.Results All varicose vein labeled before operation were resected.Surgical time was（100±20）min in unilateral lower extremity and（147±19）min in bilateral lower extremities.Total 221patients（302 lower extremities）were followed up in 4to 46months,median follow up time was 24.5months.Total 167cases（247 lower extremities）had accepted the operation more than 1year,154cases（229lower extremities）in which were followed up.In the 229lower extremities above,recurrences occurred in 11extremities,small amounts of residual small varices were observed in 2extremities,the recurrence rate was 5.68%（13/229）.Twenty-one limbs with ulcer were healing in 3to 6 weeks after operation.Postoperative complications：there was paresthesias or pain of ankle area in 16limbs,which was improved in 3to 6months after physical therapy;there was ecchymosis of skin of leg in 112limbs,which disappeared in 3 to 5weeks after operation;there was light edema in 37limbs,which disappeared in 1to 2weeks after operation;there was local hematoma in 2limbs,incision light infection in 5limbs,skin and subcutaneous tissue necrosis above medial malleolus in one limb,and back of knee popliteal skin lesion in 2limbs,which were all cured by the symptomatic treatment.Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures.Varicosevein extraction using transilluminated powered phlebectomy is safe,e

关 键 词：透光动力旋切术 大隐静脉 静脉曲张 血管外科手术 美观 

分 类 号：R654.4[医药卫生—外科学]