腔内激光联合泡沫硬化杂交手术治疗下肢静脉曲张126例  

A hybrid technique of laser intracavity obstruction and foam sclerosant in treating varicose vein of the lower extremity

作　　者：姜建威[1] 吴清华[1] 顾琛[1] 吴震海[1] 

机构地区：[1]无锡市第三人民医院血管介入科,江苏省214041

出　　处：《中华普通外科杂志》2015年第4期276-279,共4页Chinese Journal of General Surgery

摘　　要：目的探讨采用静脉腔内激光联合泡沫硬化杂交手术治疗下肢静脉曲张的临床疗效。方法2009年4月至2013年4月收治126例（175条患肢）原发性大隐静脉曲张患者，采用静脉腔内激光结合小腿泡沫硬化杂交手术。术中采用导管导丝技术将光纤置于隐股静脉瓣下方，对大隐静脉主干采用激光消融治疗，对于胫骨结节下4cm以远的大隐静脉主干和直径〈6mm的浅表曲张静脉，则予泡沫硬化治疗。术后随访3～24个月，观察患肢手术时间、患者平均住院天数、生活质量评分、中期疗效以及并发症情况。分别在出院时和3个月评价采用CT血管造影评价下肢曲张静脉及主干闭塞情况，血管有无复发再通。结果126例患者技术成功率均为100％。单肢平均手术时间分别是（32±7）min；住院天数（4．2±1．8）d，生活质量评分（40±7）分。出院及3个月时CT血管造影复查分别有97条（55．42％）、111条（63．42％）患肢下肢曲张静脉消失，78条（44．57％）、64条（36．57％）患肢下肢曲张静脉明显减少，143条（81．71％）、158条（90．28％）患肢大隐静脉主干闭塞，32条（18．28％）、17条（9．71％）患肢大隐静脉管腔变窄，未见血管复发再通。生活质量评分（73±4）分。并发症有隐神经损伤5例，软组织感染5例，小腿皮肤灼伤11例，局部条索状斑块状硬结32例，水肿16例，皮下血肿10例。本组未见肺栓塞、深静脉血栓形成并发症。结论腔内激光联合泡沫硬化杂交治疗下肢静脉曲张具有较高的治愈率，手术时间短，并发症少。Objective To evaluate the clinic effect of a hybrid technique of laser and foam sclerosant in treating varicose vein of the lower extremity. Methods From April 2009 to April 2013, hybird operation of endovenous laser combined with foam sclerosant was carrird out in 126 patients with lower extremity varicosities. A total 175 diseased legs were treated. Catheter guidewire techniques was performed first in placing optical fiber below saphenous vein flap, which was followed by laser ablation for the great saphenous vein, then foam sclerotherapy were used for greater saphenous vein trunk 4 cm below tibial tubercle and the superficial varicose veins with diameter less than 6 mm. All patients were followed up for 3 - 24 months. The operation time, average hospitalization days, patients quality of life score, curative effect and complications were analyzed. CT angiography in the evaluation of occlusion of varicose vein of lower limbs trunk and recurrence were performed at the time of discharge and three months later respectively. Results Hybrid operation of endovenous laser treatment and foam sclerosant was successfully performed in all cases. The procedure time for a single leg was （ 32 ± 7 ） minutes ; the quality of life score and the hospitalization after procedure was （ 4. 2 ± 1.8 ） days and （40 ± 7 ） score respectively. CT angiography at discharge and 3 months later revealed that 97 （ 55.42% ） and 111 （ 63.42% ） limbs varicose veins disappeared respectively, 78 （ 44.57% ）, 64 （ 36. 57% ） lower limb varicose veins was reduced respectively, 143 （81.71%）, 158 （90. 28% ） great saphenous vein trunk were in emphraxis respectively and 32 （ 18.28% ） , 17 （9. 71% ） great saphenous vein lumen were narrowed. No vascular recanalization was found. The complications included saphenous nerve injury in 5 cases, soft tissue infection in 5 cases, calf skin burn in 11 cases, local funicular patches nodules in 32 cases, edema in 16 cases, subcutaneous hematoma in 10 cases. No complications

关 键 词：静脉曲张 血管外科手术 激光疗法 硬化疗法 

分 类 号：R543.6[医药卫生—心血管疾病]