CAJ | 학술논문

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4 cm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.
목적 탐토채용정맥강내격광연합포말경화잡교수술치료하지정맥곡장적림상료효.방법 2009년4월지2013년4월수치126례(175조환지)원발성대은정맥곡장환자,채용정맥강내격광결합소퇴포말경화잡교수술.술중채용도관도사기술장광섬치우은고정맥판하방,대대은정맥주간채용격광소융치료,대우경골결절하4 cm이원적대은정맥주간화직경＜6mm적천표곡장정맥,칙여포말경화치료.술후수방3～24개월,관찰환지수술시간、환자평균주원천수、생활질량평분、중기료효이급병발증정황.분별재출원시화3개월평개채용CT혈관조영평개하지곡장정맥급주간폐새정황,혈관유무복발재통.결과 126례환자기술성공솔균위100％.단지평균수술시간분별시(32±7) min;주원천수(4.2±1.8)d,생활질량평분(40±7)분.출원급3개월시CT혈관조영복사분별유97조(55.42％)、111조(63.42％)환지하지곡장정맥소실,78조(44.57％)、64조(36.57％)환지하지곡장정맥명현감소,143조(81.71％)、158조(90.28％)환지대은정맥주간폐새,32조(18.28％)、17조(9.71％)환지대은정맥관강변착,미견혈관복발재통.생활질량평분(73±4)분.병발증유은신경손상5례,연조직감염5례,소퇴피부작상11례,국부조색상반괴상경결32례,수종16례,피하혈종10례.본조미견폐전새、심정맥혈전형성병발증.결론 강내격광연합포말경화잡교치료하지정맥곡장구유교고적치유솔,수술시간단,병발증소.
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 such as pulmonary embolism,and deep venous thrombosis happened.Conclusions For the treatment of lower extremity varicosities,hybrid operation of laser and foam sclerosant ablation have high limb cure rate,less operation time and complications.