腔内激光联合手术治疗下肢静脉曲张的评价

目的 评价腔内激光(EVLT)联合手术治疗下肢静脉曲张的疗效.方法 下肢静脉曲张172例,198条下肢.按不同病因分为3组,采用EVLT 相应手术方法治疗:①A组:原发性下肢深静脉瓣膜功能不全45条患肢,行股浅静脉瓣膜包窄 EVLT 内镜下小腿内侧功能不全交通静脉离断术(SEPS);②B组:轻度原发性深静脉瓣膜功能不全55条下肢,行EVLT SEPS;③C组:单纯性大隐静脉曲张,98条下肢,行EVLT.结果 随访2～44个月,平均32个月,5例有曲张静脉复发,再次行EVLT后未再复发;其余167例症状消退或明显好转,溃疡均愈合,彩超示大隐静脉全程闭合,深静脉通畅.结论 EVLT具有微创、安全、易于操作的特点,联合手术治疗下肢静脉曲张的效果满意.     

下肢静脉曲张腔内激光治疗158例分析

目的:评价下肢静脉曲张腔内激光治疗的疗效。方法:158例下肢静脉曲张患者(194侧患肢),单纯行腔内激光治疗(大隐静脉主干结扎)56例(83侧患肢),激光联合大隐静脉高位结扎术(大隐静脉主干及五个分支均结扎)92例(99侧患肢),激光联合大隐静脉高位结扎术并点式切口剥脱严重曲张浅静脉10例(12侧患肢);术后观察下肢疼痛、皮下血肿等并发症、住院时间及近期疗效情况。结果:158例术后均无严重并发症发生,术后随访2～24个月,疗效满意。1例术后2个月复发,1例术后大隐静脉主干血栓样硬结现象较明显,1例隐神经损伤残留内踝区麻木。结论:下肢静脉曲张腔内激光治疗是一种穿刺代替切口、简化操作、恢复快、腿部不留瘢痕或减少瘢痕、疗效可靠的手术方法。     

腔内射频联合激光和手术治疗下肢静脉功能不全的初步报道

目的评价腔内射频联合激光和手术治疗下肢静脉功能不全的安全性和有效性。方法33例患者34条患肢,单纯性大隐静脉曲张10条,原发性深静脉瓣膜功能不全20条,左髂静脉受压综合征2条,下肢静脉畸形-骨肥大-皮肤血管瘤综合征2条。3种治疗方式：①大隐静脉主干射频闭锁联合股浅静脉瓣膜包窄术、大隐静脉高位结扎和曲张属支浅静脉腔内激光（EVLT）治疗4条肢体：②大隐静脉主干射频闭锁联合大隐静脉高位结扎和EVLT治疗28条肢体;③大隐静脉主干射频闭锁联合外侧畸形静脉高位结扎和EVLT治疗2条肢体。结果随访1～15个月,平均3．27个月,33例患者均取得满意的疗效。结论主干静脉腔内射频治疗下肢静脉功能不全操作简便、安全、有效、微创,联合EVLT和手术治疗,可扩大其应用范围。     

隐股静脉瓣下大隐静脉结扎联合腔内激光术治疗下肢静脉曲张性溃疡

目的 探讨隐股静脉瓣下大隐静脉结扎联合腔内激光术（EVLT）治疗下肢静脉曲张性溃疡的疗效.方法 选择收治的70例（74条患肢）下肢静脉曲张性溃疡患者,随机分为观察组和对照组,每组各35例,观察组施行隐股静脉瓣下大隐静脉结扎联合EVLT术,对照组采用传统大隐静脉高位结扎联合点状静脉抽剥术,对比观察两组患者的疗效.结果 术后随访6～ 10个月,观察组治疗总有效率94.59％,对照组81.08％,观察组疗效优于对照组.观察组溃疡愈合时间、术后疼痛发生率、切口感染率及隐神经损伤发生率均显著低于对照组.皮肤坏死、踝部水肿消失发生率,两组差异无统计学意义（P＞0.05）.观察组溃疡复发率低于对照组（P＜0.05）.结论 隐股静脉瓣下大隐静脉结扎联合EVLT术治疗下肢静脉曲张性溃疡疗效显著,其操作简单、创伤小、恢复快、复发率低,优于传统术式,值得推广应用.     

静脉腔内激光联合手术治疗下肢静脉曲张

目的初步评价腔内激光联合手术治疗下肢静脉曲张的疗效。方法全组下肢静脉曲张患者28例，共38条下肢。按病因和病情的不同，采用3种手术治疗：（1）临床表现明显的原发性下肢深静脉瓣膜功能不全者4条下肢，作股浅静脉瓣膜包窄＋大隐静脉高位结扎＋EVLT＋SEPS术；（2）轻度原发性深静脉瓣膜功能不全者15条下肢，作大隐静脉高位结扎＋EVLT＋SEPS；（3）单纯性大隐静脉曲张者19条下肢，作大隐静脉高位结扎＋EVLT。结果平均随访11个月，全组患者均无复发；临床症状和体征消退或好转，彩超检查示大隐静脉均全程闭合，无血流信号。结论EVLT具有无创、安全、操作简便和疗效良好的优点，联合手术治疗下肢静脉病变的效果满意。     

DIOMED激光联合手术治疗下肢静脉曲张疗效探讨

目的探讨激光联合手术治疗下肢静脉曲张的疗效及并发症。方法传统手术方法高位结扎剥脱大隐静脉主干,腔内激光治疗下肢浅表曲张静脉,观察75例96条患肢术后刀口愈合情况及并发症。结果所有患肢切口愈合良好,术后曲张浅静脉全部消失,23条患肢出现皮下淤血,12例出现小腿局部条索状硬块、红肿及疼痛,隐神经损伤导致皮肤麻木2例,皮肤灼伤2例,经对症治疗后好转。结论激光联合手术治疗下肢静脉曲张疗效好,创伤小,是一种安全的治疗方法。     

腔内激光联合Trivex 旋切术治疗重度下肢浅静脉曲张的临床效果

目的：探讨腔内激光治疗术联合Trivex旋切术治疗重度下肢浅静脉曲张的临床疗效。 方法：分析2012年7月—2013年10月收治的20例（26条肢体）重度下肢原发性下肢静脉曲张患者临床资料。患者均行腔内激光治疗术联合Trivex旋切术治疗。 结果：全部患者顺利完成手术。术后下肢静脉曲张均消失,色素沉着、瘙痒、湿疹、皮肤溃疡等并发症不同程度的减轻;并发皮下淤斑、局部肿胀4例,均在1个月内消失;1例出现患肢小腿外侧肿胀,穿刺抽吸积液并以弹力绷带加压包扎后肿胀消退;2例出现患肢皮肤麻木,2个月后消失;2例大隐静脉主干部位和曲张静脉烧灼处出现条索状硬结,并伴有局部轻中度疼痛,2~3周症状逐渐消失。术后平均随访8个月,无曲张静脉复发及小腿无明显瘢痕。 结论：腔内激光治疗术联合Trivex旋切术对原发性下肢静脉曲张具有良好的治疗效果治疗,且具有微创及美容效果好等优点。     

大隐静脉高位结扎联合腔内激光治疗下肢浅静脉曲张

目的探讨大隐静脉高位结扎联合腔内激光(EVLT)治疗下肢浅静脉曲张的临床效果。方法回顾性分析42例(57条肢体)下肢静脉曲张病例,所有病例均采用外科高位结扎联合EVLT术,术后观察治疗效果及近远期并发症。结果术后患者均恢复良好,曲张静脉团块消失,酸胀不适感消失;术后部分患出现沿大隐静脉走行条索状硬块,肢体肿胀等并发症,对症治疗后均消失,3条肢体(5.2%)出现点状皮肤灼伤,1条肢体(1.7%)出现皮肤麻木,1条肢体(1.7%)复发。结论大隐静脉高位结扎联合腔内激光治疗下肢浅静脉曲张疗效可靠,并发症发生率低,创伤小,复发率低。     

不同方法治疗下肢静脉曲张临床分析

目的探讨不同方法治疗下肢静脉曲张的效果. 方法 1994年1月～2005年1月对236例(319条患肢)下肢静脉曲张,分别采用大隐静脉高位结扎抽剥法136例(184条患肢)、高位结扎抽剥联合皮下连续环形缝扎法63例(86条患肢)、腔内激光照射法7例(9条患肢)、关节镜下微创刨削法30例(40条患肢)进行治疗,其中关节镜刨削法通过小腿2个小切口分别放置关节镜与刨削系统,对曲张成团的浅静脉刨削抽吸清除. 结果术后出现皮下血肿、局部轻度硬肿等不良反应,经处理后3～5周内消失.207例(87.7%)275条患肢术后随访3～12个月,平均10.6月,其中激光组7例与关节镜组30例全部随访.术后患肢酸胀坠痛感消失,疼痛及跛行消失,137条肢体慢性溃疡有125条在术后3～6周愈合. 结论 4种方法有其各自的适应证,关节镜下微创刨削清除下肢浅静脉曲张安全、有效、创伤小、并发症少,是治疗下肢浅静脉曲张的一种新方法.     

内镜深筋膜下穿通静脉离断联合腔内激光治疗下肢静脉曲张

目的: 探讨内镜深筋膜下穿通静脉离断术（subfascial endoscopic perforator surgery, SEPS）联合腔内激光治疗（endovenous laser treatment,EVLT）术治疗下肢静脉曲张的可行性。方法: 2016年8月至2017年10月,静脉顺行造影诊断下肢穿通静脉瓣膜功能不全患肢81条,选择40条患肢行SEPS术,联合EVLT术闭合浅表曲张静脉,保留健康大隐静脉作为研究组;41条患肢作为对照组,行传统大隐静脉高位结扎抽剥术。结果: 研究组曲张静脉团块消失,下肢静脉血淤滞得到缓解,色素沉着减轻,溃疡愈合,随访5~11个月无复发。研究组手术时间少于对照组（1.1 h比3.0 h）,切口数也少于对照组（2.1个比5.8个）,住院时间缩短（1.1 d比3.9 d）,下肢淤斑面积减少（5.2 cm³比20.3 cm³）,差异均有显著统计学意义（P<0.01）。结论: SEPS联合EVLT术适合个体化微创治疗下肢静脉曲张,创伤小、恢复快。     

腔内激光联合手术治疗下肢静脉曲张的实验和临床研究

目的评价改进腔内激光(EVLT)联合手术治疗下肢静脉曲张的疗效。方法下肢静脉曲张90例116条下肢。按病因和病情采用3种手术治疗(1)A组临床表现明显的原发性下肢深静脉瓣膜功能不全24条下肢,作股浅静脉瓣膜包窄 大隐静脉高位结扎 EVLT 内镜下小腿内侧交通静脉离断术SEPS;(2)B组轻度原发性深静脉瓣膜功能不全26条下肢,作大隐静脉高位结扎 EVLT SEPS;(3)C组单纯性大隐静脉曲张66条下肢,作大隐静脉高位结扎 EVLT。结果平均随访20个月,3组患者均无复发,临床症状和体征消退或好转,溃疡均愈合。彩超检查示大隐静脉全程闭合,无血流信号,深静脉回流通畅。结论EVLT具有微创、安全、操作简单和疗效良好的优点,针对病因和病情联合不同手术治疗下肢静脉病变效果满意。     

Endovenous laser ablation of varicose veins: review of current technologies and clinical outcome

Symptomatic lower extremity varicose veins represent one of the most common vascular conditions in the adult population. Associated symptoms ranged from mild conditions such as fatigue, heaviness, and itching to more serious conditions such as skin discoloration and leg ulceration. The predominant causative factor of this condition is reflux of the great saphenous vein (GSV), which is traditionally treated with surgical saphenofemoral ligation and stripping of the incompetent saphenous vein. In recent years, there have been significant advances in saphenous vein ablation using percutaneous techniques, including the endovenous laser therapy (EVLT). In this article, the authors discuss the therapeutic evolution of this technology, theoretical basis of laser energy in GSV ablation, and procedural techniques of EVLT using duplex ultrasonography. Additional discussion of procedural-related complications, such as deep vein thrombosis, skin burn, saphenous nerve injury, and phletibis, and ecchymosis, are provided. Lastly, clinical results of EVLT in GSV ablation are discussed. Current literatures support EVLT as a safe and effective treatment option for varicosities caused by GSV incompetence.     

大隐静脉曲张腔内激光治疗术后并发症原因分析及预防

目的探讨腔内激光治疗（endovenous laser treatment,EVLT）大隐静脉曲张术后并发症发生原因及防治。方法回顾我院2003年8月～2007年2月采用大隐静脉高位结扎联合EVLT治疗342例（530条肢体）大隐静脉曲张,分析术后186条肢体出现的并发症。结果随访6个月,23条肢体皮下淤血、血肿,65条肢体静脉炎反应,20条肢体皮肤烧伤,经治疗全部治愈。77条肢体隐神经损伤（皮肤感觉异常）,经治疗57条治愈,余20条好转。1例深静脉血栓形成并发肺栓塞,经治疗好转。结论EVLT术中联合大隐静脉高位结扎,根据部位适当调整激光功率,轻柔操作,术后早期活动及预防性抗凝等措施,可预防或减少并发症的发生。     

静脉腔内激光治疗下肢静脉曲张的疗效观察

目的　评价静脉腔内激光治疗下肢静脉曲张的疗效。方法　 46例患者共 5 4条患肢行单纯激光治疗或大隐静脉高位结扎加激光治疗。结果　所有患者的静脉曲张均闭塞。 19.5 %患者出现肢体淤斑 ,81.5 %患者肢体发生沿大隐静脉行程条索状硬结或硬块 ,11.1%患者皮肤局部麻木 ,1例患者发生皮肤浅表烧伤。所有患者均获随访 ,平均随访 6个月 (3～ 8个月 ) ,均痊愈。无深静脉血栓 ,无局部复发 ,疗效满意。结论　静脉腔内激光治疗是一种安全、有效、微创的治疗方法 ,选择大隐静脉高位结扎加激光治疗则更安全。     

腔内激光与腔内激光联合泡沫硬化剂治疗下肢静脉曲张的比较研究

目的探讨腔内激光联合泡沫硬化剂治疗下肢静脉曲张的疗效和安全性。方法 2010年7月～2011年10月将120例下肢静脉曲张按就诊顺序编号,每10例为一分配单元,1～10号为单纯激光组,11～20号为联合治疗组,以此类推,每组60例。单纯激光组:大隐静脉高位结扎后,用980 nm波长半导体激光腔内治疗大隐静脉主干、大隐静脉属支及曲张的静脉团;联合治疗组:大隐静脉高位结扎后,用980 nm波长半导体激光腔内激光治疗大隐静脉主干,泡沫硬化剂5 ml(1 ml聚桂醇注射液及4 ml空气经三通器混合制成5 ml泡沫硬化剂,现用现配)静脉注射治疗属支静脉及静脉团。结果所有患者随访6～12个月,平均9个月。单纯激光组痊愈56例,显效4例,总有效率100%;联合治疗组痊愈58例,显效2例,总有效率100%,2组疗效比较差异无显著性(Z=-0.834,P=0.404)。2组术后复发率无统计学差异[6.7%(4/60)vs.3.3%(2/60),χ2=0.175,P=0.675]。腔内激光组并发症发生率为35.0%(21/60),联合治疗组并发症发生率为3.3%(2/60),2组比较差异有显著性(χ2=19.417,P=0.000)。结论与单纯腔内激光治疗比较,腔内激光联合泡沫硬化剂治疗下肢静脉曲张并发症少,疗效无差别。     

Endovenous laser treatment combined with a surgical strategy for treatment of venous insufficiency in lower extremity: a report of 208 cases

BACKGROUND: We assessed the safety and efficacy of endovenous laser treatment (EVLT) of the saphenous vein combined with a surgical strategy for treatment of deep venous insufficiency in the lower extremity. METHODS: Two hundred thirty venous insufficiencies of the lower limbs in 208 consecutive patients (93 men and 115 women; mean age, 54.15 years) were treated with EVLT combined with surgical strategies. All patients were symptomatic. There were 84 limbs (36.5%) in C(2), 25 (10.9%) in C(3), 109 (47.7%) in C(4), 1 (0.4%) in C(5), and 9 (3.9%) in C(6) (CEAP), and Klippel-Trenaunay syndrome was present in 2 limbs. A total of 119 (51.7%) had perforator vein incompetence. Four therapeutic methods were included in this series according to symptoms, CEAP classification, and venous reflux. Simple EVLT was performed for 15 patients with only great saphenous vein (GSV) incompetence or Klippel-Trenaunay syndrome in 19 lower limbs. EVLT combined with high ligation of the GSV and open ligation of perforators was performed for 5 patients with GSV and perforator incompetence in 5 lower limbs. EVLT was combined with high ligation of the GSV for 76 patients with GSV incompetence in 94 lower limbs. EVLT was combined with external banding of the first femoral venous valve and high ligation of the GSV for 112 patients with primary deep venous insufficiency in 112 lower limbs. All patients were followed up on an outpatient basis for physical examinations and postoperative complaints, and duplex ultrasonography was performed 2 weeks, 6 months, and 1 year after operation. RESULTS: All patients tolerated the procedure well and returned to normal daily activities immediately, achieving a 100% immediate clinical success rate. Spot skin burn injuries occurred in 2 patients (1.0%). Paresthesia in the gaiter area was noted in 15 patients (7.2%). No postprocedural symptomatic deep venous thrombosis or pulmonary embolism occurred. Three patients had local recurrent varicose veins in the calf (1.4%) during a 2- to 27-month follow-up (mean, 6.12 months). Postoperative clinical classes were significantly improved between 2 weeks and 24 months (P = .0001 at 2 weeks and 3 to 18 months; P = .0055 at 24 months compared with before operation), especially in preoperative C(2) to C(3) stage patients, who achieved complete amelioration. CONCLUSIONS: EVLT is a novel minimally invasive treatment with advantages of safety, effectiveness, and simplicity, and it leaves no scars. Its indications can be expanded by combining EVLT with surgical strategies.     

逆行静脉腔内射频闭合并点状抽剥治疗下肢静脉曲张

目的探讨逆行静脉腔内射频闭合并点状抽剥法治疗下肢静脉曲张的效果。方法本组在2005年3月-2007年5月对25例原发性大隐静脉曲张患者,共38条患肢的曲张大隐静脉采用数控射频静脉闭合系统逆行闭合大隐静脉主干并同时用点状抽剥法治疗小腿散在曲张浅静脉。结果随访1～24个月,所有患者大隐静脉主干均闭合良好,无复发,近期疗效满意。结论逆行静脉腔内射频闭合并点状抽剥法治疗下肢静脉曲张具有术式简便、创伤少、疗效可靠、康复快、住院时间短等优点。