超声引导下腔内射频闭合术联合局部点剥治疗下肢静脉曲张  

Ultrasound Guided Radiofrequency Endovenous Obliteration Combined With Local Point Stripping in the Treatment of Varicose Veins of Lower Extremity

作　　者：冯琦琛[1] 王昌明[1] 李选[1] 杨广鑫 Feng Qichen, Wang Changming, Li Xuan, et al.(Department of Vascular Surgery, Peking University Third Hospital, Beijing 100191, Chin)

机构地区：[1]北京大学第三医院介入血管外科,北京100191

出　　处：《中国微创外科杂志》2018年第7期577-580,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨超声引导下腔内射频闭合术(radiofrequency endovenous obliteration,RFO)联合局部点剥治疗下肢静脉曲张的近期疗效。方法 2016年2~10月我科采用RFO联合局部点剥治疗下肢静脉曲张218例共272条肢体。术前均行下肢静脉超声检查,明确存在隐静脉返流,返流时间大于500 ms,同时除外下肢静脉血栓形成。超声引导下21G穿刺针穿刺隐静脉主干,引入7F 11 cm鞘管。经鞘管导入射频治疗导管,超声定位位置准确后固定导管。超声引导下自大隐静脉置入鞘管部位至导管末端位置行膨胀麻醉。超声探头直视导管工作段,同时加压工作段所在区域隐静脉,打开射频行腔内射频闭合术。主干静脉处理完毕后,术前标记处1%利多卡因局麻,1~2 mm小切口行局部曲张静脉点状剥脱术。术后局部切口敷料覆盖。术后即刻穿医用循序减压弹力袜。结果手术成功率100%。术中并发症7例,其中6例为一过性心率加快、血压升高,1例为一过性心率减慢。术后2例并发症均为局部静脉剥脱切口术后活动性出血,均发生在术后1 h内。随访173例222条肢体,术后3个月复查,静脉曲张完全消失84条,临床分级降级136条,有效率99.1%(220/222)。结论超声引导下RFO联合局部点剥治疗单纯性下肢静脉曲张微创、安全、有效,近期疗效满意。Objective To discuss the short-time effect of ultrasound guided radiofrequency endovenous obliteration（ RFO）combined with local point stripping in the treatment of varicose veins of lower extremity. Methods A total of 218 patients（ 272 limbs） were treated with RFO combined with local point stripping from February to October 2016 in our hospital. All the patients underwent preoperative ultrasound examination of the lower extremity,which was characterized by the presence of saphenous vein reflux. The reflux time was greater than 500 ms. Meantime,lower extremity venous thrombosis was excluded. Under ultrasound guidance,a 21 G needle was used to puncture the saphenous vein trunk,and a 7 F 11 cm sheath was introduced. A radio frequency catheter was inserted through the sheath tube and fixed under ultrasound orientation. The great saphenous vein sheath was placed to distal end of the catheter position for swelling anesthesia. Under ultrasonic probe direct vision of catheter working section,the saphenous vein at the working section area was pressed and intracavitary radiofrequency closure was performed. After the management of the main vein,local anesthesia was given at preoperative marking site with 1% lidocaine,and local point stripping of varicose vein with 1-2 mm small incisions was performed. After operation,the local incisions were covered with dressings,and medical decompression stockings were utilized immediately. Results The success rate was 100%. There were 7 cases of intraoperative complications,including 6 cases of transient tachycardia and hypertension and 1 case of transient bradycardia. The postoperative complications were 2 cases of active bleeding after local vein stripping,which occurred within 1 hour after operation. A total of 173 patients（ 222 limbs） were followed up. At the 3 months after operation,the varicose veins disappeared completely in 84 limbs and clinical classification was degraded in 136 limbs. The effective rate was 99. 1%（ 220/222）. Conclusion Ultrasound guided RFO comb

关 键 词：下肢静脉曲张 超声引导腔内射频闭合术 膨胀麻醉 

分 类 号：R654.4[医药卫生—外科学]