CAJ | 학술논문

目的：探讨腔内激光消融(EVLT)联合泡沫硬化术治疗下肢静脉曲张的临床疗效。方法2011年6月至2012年12月，中山大学附属第三医院介入血管科采用EVLT联合泡沫硬化术治疗下肢静脉曲张患者101例（120条肢体）。101例患者均先行大隐静脉高位结扎；104条肢体从大隐静脉结扎处穿刺逆行送入激光导丝闭合大隐静脉主干，16条肢体从足踝处穿刺顺行送入激光导丝闭合大隐静脉主干；大隐静脉属支和曲张静脉团块头皮针穿刺见回血后，注入聚桂醇和空气（按1︰4比例配制）混合泡沫；溃疡患者，距离溃疡边缘约1 cm，环形注射聚桂醇纯液。结果101例手术均获成功，单侧手术平均时间为46 min，双侧手术平均时间为81 min；住院时间平均4 d。3例患者术中出现胸闷，未经处理自行好转；2例患者出现咽喉瘙痒、咳嗽及皮疹等过敏症状，经抗过敏处理后缓解。术后随访3~14个月，2例部分曲张静脉残留，经再次泡沫硬化治疗而痊愈；16例活动性溃疡的患者，1例未愈，2例术后6个月复发；11例患者发生血栓性静脉炎，经理疗后痊愈。结论腔内激光消融及泡沫硬化术治疗下肢浅静脉曲张简便、安全、有效、并发症少。
목적：탐토강내격광소융(EVLT)연합포말경화술치료하지정맥곡장적림상료효。방법2011년6월지2012년12월，중산대학부속제삼의원개입혈관과채용EVLT연합포말경화술치료하지정맥곡장환자101례（120조지체）。101례환자균선행대은정맥고위결찰；104조지체종대은정맥결찰처천자역행송입격광도사폐합대은정맥주간，16조지체종족과처천자순행송입격광도사폐합대은정맥주간；대은정맥속지화곡장정맥단괴두피침천자견회혈후，주입취계순화공기（안1︰4비례배제）혼합포말；궤양환자，거리궤양변연약1 cm，배형주사취계순순액。결과101례수술균획성공，단측수술평균시간위46 min，쌍측수술평균시간위81 min；주원시간평균4 d。3례환자술중출현흉민，미경처리자행호전；2례환자출현인후소양、해수급피진등과민증상，경항과민처리후완해。술후수방3~14개월，2례부분곡장정맥잔류，경재차포말경화치료이전유；16례활동성궤양적환자，1례미유，2례술후6개월복발；11례환자발생혈전성정맥염，경리료후전유。결론강내격광소융급포말경화술치료하지천정맥곡장간편、안전、유효、병발증소。
Objective To evaluate the efficacy and safety of endovenous laser treatment (EVLT) combined with foam sclerotherapy for varicose veins of the lower limbs. Methods A total of 101(120 limbs) cases of lower extremities varicosity patients were treated with EVLT combined with foam sclerotherapy from June 2011 to December 2012 ,with proximal ligation of the great saphenous vein (GSV) performed ifrst. After inserting retrogradely (from the point of ligation of GSV to ankle) or anterogradely (from ankle to the ligation of GSV) the optical ifber, the trunk of the GSV was treated with EVLT at a wave length of 810 nm. Sclerosing foam (a mixture of 1 ml lauromacrogol solution with 4 ml air) was then injected into the tributary of the GSV and varicose vein cluster. Results EVLT combined with foam sclerotherapy was performed successfully in all 101 cases at an average hospital stay of 4 days. Three patients developed chest tightness which improved spontaneously without speciifc treatment. Two patients were complained post-operatively of itchy throat and cough which relieved after anti-allergy treatment .Patients were followed up for 3-14 months, and 2 cases of partial residual varicose veins were treated by foam sclerotherapy again. Sixteen patients presented with active ulcer. Wound healing was achieved in 13 cases, 1 case remained unhealed, and relapse was seen in 2 cases after 6 months. Eleven cases with thrombophlebitis were managed with physiotherapy. Conclusion EVLT combined with foam sclerotherapy is an effective approach with minimal invasion, simple manipulation and less complications.