1470 nm激光微创综合治疗高龄下肢静脉淤积性溃疡  

Comprehensive and Minimally Invasive Treatment of Venous Stasis Ulcers of Lower Extremity in the Elderly with 1470nm Laser

作　　者：黄钧新 王春喜 曾晶 疏丹 刘庆 吴荣亮 杜毅 HUANG Junxin;WANG Chnxi;ZENG Jing;SHU Dan;LIU Qing;WU Rongliang;DU Yi(Department of general surgery,the Cancer Hospital Affiliated to Hainan Medical College,Haikou 570000,China;Department of General Surgery,the First Medical Center of the Chinese PLA General Hospial;Department of Laser Medicine,the First Medical Center,Chinese PLA General Hospital;Department of General Surgery Hainan Hospital of the Chinese PLA General Hospital;Department of Laser Medicine,the Hainan Hospital,Chinese PLA General Hospital;Shenzhen Institute of Precision Medicine)

机构地区：[1]海南医学院附属肿瘤医院综合外科,海口市570000 [2]中国人民解放军总医院第一医学中心普外科 [3]中国人民解放军总医院海南医院普外科 [4]中国人民解放军总医院第一医学中心激光医学科 [5]中国人民解放军总医院海南医院激光医学中心 [6]深圳市精准医学研究院

出　　处：《中国激光医学杂志》2022年第3期121-125,共5页Chinese Journal of Laser Medicine & Surgery

基　　金：国家重点研发计划项目(2018YFB0407200);三亚市医药卫生科技创新项目(2019YW03)。

摘　　要：目的探讨波长1470 nm激光微创综合治疗高龄下肢静脉淤积性溃疡的新方法。方法回顾性分析2016年1月至2020年1月,静脉淤积性溃疡患者21例的临床资料,年龄70~82岁,设为激光组均行激光微创血管闭合技术治疗,治疗波长为1470 nm,治疗功率6 W;同时纳入同期同龄的患者设为对照组,采用传统手术治疗。分别于手术前和手术后1、2、4、6、8和16周,观察两组患者溃疡大小的变化;记录两组患者手术所需时间、术中出血量、溃疡周围切口大小,以及术后溃疡愈合时间。术后24 h采用视觉模拟评分法(visual analogue scales,VAS)评估切口疼痛情况。并记录皮瓣坏死等不良反应发生情况。术后随访1~2年,比较两组患者复发率。结果两组手术耗时分别为激光组(52.7±9.0)min、传统手术组(95.5±15.9)min,差异具有显著意义(P<0.01);激光组手术出血(5.14±2.3)ml,传统手术出血量(47.1±6.6)ml,两组比较差异具有显著意义(P<0.01)。术后24 h疼痛反应分别为:激光组(1.48±0.6)分、传统手术组(5.33±1.5)分,两组比较差异具有显著意义(P<0.01)。传统手术组出现4例皮瓣坏死,激光治疗组无皮瓣坏死现象。术后溃疡愈合时间比较,激光组术后溃疡愈合时间短于传统手术组(P<0.01)。两组患者随访1~2年,均无复发。结论激光微创综合治疗下肢静脉淤积性溃疡的方法简便易行、创伤小、恢复快、疗效较好,适合高龄静脉性溃疡的治疗。Objective Objective To explore the new laser-based minimally invasive method to treat venous stasis ulcers of lower extremity in the elderly.Methods Totally 21 patients with venous stasis ulcers admitted to the hospital during the period from Jan.2016 to Jan.2020 were given the minimally invasive vascular closure with 1 470 nm laser(power:6 W).At the same time,certain patients of the same age and admitted to the hospital during the same period were included and given traditional surgery,which composed the control group.The change of.ulcer size was observed 1,2,4,6,8 and 16 weeks respectively after the surgery.The operative time,intraoperative bleeding,peripheral incision size,and postoperative ulcer healing time were recorded.Incision pain was assessed with visual analog scoring(visual analogue scales) 24 h after the operation.The complications such as flap necrosis were also recorded.The recurrence rate was compared between the two groups 1-2 years after the operation.Results The operation time of the laser surgery group and conventional surgery group was(52.7±9.0) min and(95.5±15.9) min respectively,indicating a difference that was statistically significant,(P<0.01).The surgical bleeding was(5.14±2.3) ml in the laser group and(47.1±6.6) ml in the conventional surgical group,and the difference was significant(P<0.01).The 24 h pain score of the laser group and traditional surgery group was(1.48±0.6) and(5.33±1.5) respectively,and the difference was significant(P<0.01).While no case of necrosis appearing in the laser group,4 cases was found in the traditional surgery group.The postoperative ulcer-healing time in the laser group was shorter than that in the traditional surgery group(P<0.01).Conclusions Laser-based minimally invasive and comprehensive treatment is recommended for the lower limb venous stasis ulcers of the elder as it is simple and easy to conduct and brings in such benefits as less trauma,fast recovery and good curative effect.

关 键 词：激光 微创 静脉溃疡 高龄 

分 类 号：R616.4[医药卫生—外科学] R543.6[医药卫生—临床医学]