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作 者:王春喜 刘庆 曾晶 肖占祥[3] 杜毅 徐明月 刘志为 WANG Chunxi;LIU Qing;ZENG Jing;XIAO Zhan-xiang;DU Yi;XU Ming-yue;LIU Zhi-wei(Departmentof General Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya 570013, Hainan, China;Department of Laser Medicine, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China;Department of the Vascular Surgery, Hainan General Hospital, Haikou 570311, Hainan, China)
机构地区:[1]中国人民解放军总医院海南医院普通外科,三亚572013 [2]中国人民解放军总医院第一医学中心激光科,北京100853 [3]海南省人民医院血管外科,海口570311
出 处:《中国现代手术学杂志》2019年第1期18-20,共3页Chinese Journal of Modern Operative Surgery
基 金:国家重点研发计划(2018YFB0407203);海南省重点研发计划(ZDYF2018101);海南省自然基金创新团队项目(2017CXTD012);三亚市医疗卫生科技创新项目(2017YW20);解放军总医院转化医学项目(2016TM-036);三亚市院地科技合作项目(2017YD15)
摘 要:目的探讨激光焊接修复深静脉瓣膜功能不全的新技术,总结激光微创治疗本病的临床经验。方法选择40例深静脉瓣膜功能不全患者,在硬膜外麻醉下取股部小切口,显出股浅静脉瓣膜环,选择1 470 nm半导体激光器3W激光输出功率,折叠焊接瓣膜环,缩窄管腔修复瓣膜关闭不全,同时选用6W激光功率光凝闭合曲张的浅静脉。术后采用超声多普勒连续随访观察6~36月。结果术后6 h下床活动,手术后3 d即活动自如,术后5 d更换敷料见4例出现下肢少量瘀斑,手术后10 d完全消失。手术后7 d拆除股部皮内缝合线,切口愈合良好活动自如,原迂曲扩张的浅静脉消失。所有接受治疗病例均无皮下血肿,无皮肤灼伤,无淋巴漏或下肢水肿等并发症。手术后3、6、12、24和36个月复查,大隐静脉和曲张浅静脉均已闭合,深静脉瓣膜修复处均未见返流。平均随访16(6~36)个月,均未见复发。结论激光焊接技术修复深静脉瓣膜功能不全是一种较好的微创方法,值得临床进一步深入探讨和应用。Objective To investigate the new technique of laser welding for the repair of deep venous valve insufficiency and to summarize the clinical experience. Methods A total of 40 patients with primary deep venous valve insufficiency were selected, and the superficial femoral vein valve rings were exposed with a small femoral incision under epidural anesthesia. The femoral vein valve rings were folded and welded with the laser output power of 3 W. The valve insufficiency was repaired through venous lumen being constricted. The superficial varicose veins were closed with the laser power of 6 W through endovascular photocoagulation. The following-up was made by Doppler ultrasound for 6 to 36 months. Results All patients gained off the bed after 6 hour of the operation and free movement in 3 days. There were 4 cases appeared ecchymosis in lower extremities, which was completely disappeared within 10 days after the operation. The intradermal suture was removed on the day 7 with the wound healed well and the tortuous expansion of superficial vein disappeared. No complications as subcutaneous hematoma, skin burns, lymphatic leakage or lower extremity edema were found in all cases. At the 3, 6, 12, 24 and 36 months after the operation, the great saphenous vein and varicose superficial vein were closed, and no regurgitation was found in the repair of deep vein valve. All patients were followed up from 6 months to 36 months with an average of 16 months and no recurrence was found. Conclusion Laser welding is a good minimally invasive method for the repair of deep venous valve insufficiency, which is worthy to be further study and application.
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