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。     

腔内激光治疗下肢静脉曲张106例报告

目的 探讨腔内激光治疗（endovenous laser treatment, EVLT）下肢静脉曲张疗效. 方法 2004年3月～2006年3月对106例118条下肢静脉曲张,单纯采用EVLT 72例78条患肢、EVLT联合大隐静脉高位结扎术19例21条患肢、EVLT联合点式切口剥脱严重曲张浅静脉15例19条患肢. 结果 7条患肢小腿皮肤轻度灼伤,10条患肢有明显血栓性浅静脉炎样表现,26条肢体沿大隐静脉行程皮下小片淤斑,5条患肢出现大腿内侧大片皮下淤斑.74例80条患肢随访3～12个月,平均6个月,1例隐神经损伤,1例术后1个月复发,余73例症状均消失,多普勒超声检查大隐静脉主干闭塞,无血管再通,深静脉无血栓形成. 结论 EVLT治疗下肢静脉曲张损伤小,术后恢复快,近期疗效满意.     

射频闭合联合动力旋切治疗下肢静脉曲张

目的 探讨射频闭合联合动力旋切治疗下肢静脉曲张的效果和安全性.方法 将321例下肢静脉曲张患者分为3组: 微创治疗A组102例(129条患肢),用射频行大隐静脉全程原位闭合,小腿曲张静脉用动力旋切; 微创治疗B组97例(126条患肢),用射频行大隐静脉大腿段原位闭合,小腿曲张静脉及小腿段大隐静脉主干用动力旋切; 传统治疗组122例(142条患肢),行传统手术作对照,即大隐静脉高位结扎、抽剥,属支及交通支切除、结扎.观察3组术后治疗效果及并发症发生情况.结果 下肢肿胀、下肢乏力症状改善率,术后1周,微创治疗A、B组均高于传统治疗组(P＜0.05); 术后1个月,3组间各项临床症状改善情况比较,差异均无统计学意义(P＞0.05).术后小腿皮肤麻木、大腿瘀斑、创口血肿以及踝以下肿胀发生率比较,微创治疗A、B组明显低于传统治疗组(P＜0.05); 小腿瘀斑发生率,微创治疗A组明显低于传统治疗组(P＜0.05),微创治疗B组与传统治疗组比较差异无统计学意义(P＞0.05).本组病例无下肢深静脉血栓形成和切口感染的发生.结论 射频闭合联合动力旋切治疗下肢静脉曲张,简单可行,疗效确切.动力旋切去除静脉团效果好,但可能不适于旋切大隐静脉主干.     

激光腔内闭合术联合泡沫硬化剂注射术在大隐静脉曲张微创治疗中的应用

目的探讨激光腔内闭合术联合泡沫硬化剂注射术在大隐静脉曲张微创治疗中的临床效果。方法自2015年1月至2017年12月,对门诊收治的25例(27条患肢)下肢大隐静脉曲张患者,先用激光闭合大隐静脉主干,再以泡沫硬化剂注射小腿曲张静脉属支,然后评价其治疗效果。结果术后1周,患者下肢酸胀、乏力等症状均消失,无腓肠肌疼痛、足部明显肿胀等深静脉血栓症状。患者获随访3～12个月,24例治愈,1例小腿残留小面积曲张属支,经再次注射泡沫硬化剂后治愈。结论采用激光腔内闭合术联合泡沫硬化剂注射术治疗大隐静脉曲张,创伤较小,并发症较少,术后恢复较快,临床效果较好。     

腔内激光闭合术联合刨吸术治疗大隐静脉曲张48例体会

目的观察腔内激光闭合术联合刨吸术治疗大隐静脉曲张的疗效。方法笔者所在医院普外科2011年5月至2014年5月期间收治了大隐静脉曲张患者48例(60条患肢),对大隐静脉主干采用腔内激光闭合术,小腿曲张静脉采用刨吸术治疗。结果 48例患者共60条患肢均手术治愈,单侧皮肤小切口1~3个,单侧手术时间18~43 min,平均22.6 min。术后患肢静脉曲张均消失,酸胀感消失,色素沉着减轻或消失;患肢疼痛轻微,均未用止痛药;患肢均有不同程度的皮下青紫,术后2周~1个月恢复,均无皮下血肿发生;皮肤灼伤2例,对症治疗后愈合;踝部肿胀5例,消肿治疗后6~13 d恢复;术后并发局部皮肤麻木6例,均在3~7个月内逐渐恢复。本组患者术后随访6~36个月,平均26.7个月,2例(2条患肢)失访,获访患者均无复发。结论腔内激光闭合术联合刨吸术治疗大隐静脉曲张安全有效,创伤小,疼痛轻,恢复快,无疤痕,手术时间短,住院时间短,值得临床推广。     

腔内射频闭合术联合旋切术(Triex)治疗下肢静脉曲张(附392例报告)

目的 评价静脉腔内射频闭合术联合静脉旋切术(Triex)治疗下肢静脉曲张的疗效.方法 对 392例原发性下肢静脉曲张患者共413条患肢的大隐静脉主干采用数控射频静脉闭合系统治疗,联合Triex术治疗属支曲张静脉.结果 下肢静脉曲张均临床治愈.平均手术时间56min(40～62min),住院时间7.2d,随访12～48个月,平均32个月,所有患者曲张静脉均末见复发,疗效满意.结论 腔内射频闭合术联合Triex微创刨吸术是一种新的治疗下肢静脉曲张的方法,具有术式简单,微创,安全,美观且疗效可靠,康复快,住院时间短等优点.     

腔内射频闭合术联合旋切术治疗下肢静脉功能不全

目的 评价静脉腔内射频闭合术联合静脉旋切术(TriVex)治疗下肢静脉功能不全的疗效.方法 对392例原发性下肢静脉曲张患者共413条患肢的大隐静脉主干采用数控射频静脉闭合系统治疗,并联合TriVex术治疗属支曲张静脉.结果 下肢静脉曲张均临床治愈.随访12～48(平均32)个月,患者曲张静脉均未见复发.结论 腔内射频闭合术联合TriVex微创刨吸术是一种新的治疗下肢静脉曲张的方法,具有术式简单、微创、康复快且疗效可靠等优点.     

透光动力旋切术治疗下肢静脉曲张的疗效分析和手术体会

目的探讨透光动力旋切术(旋切术)治疗下肢静脉曲张的疗效、手术要点及临床意义。方法我院自2006年5月至2009年11月期间收治下肢浅静脉曲张患者255例(363条患肢),其中男126例,女129例。按修订后的CEAP临床分级(clinical etiology anatomic and pathophysiological classification system),C2级104条,C3级53条,C4级155条,C5级34条,C6级17条。均采用旋切术治疗,对患者进行术后随访,观察术后并发症发生情况。结果所有患者术前标记的曲张静脉均被切除,手术时间单侧患肢(100±20)min,双侧(147±19)min。术后221例患者(302条患肢)获得随访,随访时间4～46个月,中位随访时间为24.5个月;其中术后1年以上的患者167例(247条患肢),获得随访154例(229条患肢)。随访1年以上者中11条患肢复发,2条少量细小曲张静脉残留,术后1年以上复发率为5.68%(13/229)。21条肢体溃疡于术后3～6周内愈合。术后并发症:16条肢体足踝部皮肤感觉异常或疼痛,经理疗后3～6个月明显好转;112条肢体有小腿皮肤瘀斑,于3～5周后吸收消退;37条肢体出现小腿肿胀,于1～2周消退好转;2条肢体出现局部皮下血肿,5条肢体切口轻度感染,1条肢体内踝上方皮肤和皮下组织坏死,2条肢体腘窝处皮肤损伤,均经对症处理后痊愈。结论下肢静脉曲张的手术治疗实际上是多种手术方法的联合应用,旋切术治疗下肢静脉曲张的临床初步研究表明,其具有安全、简便、美观的特点。     

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。     

Trivex 微创旋切术治疗下肢静脉曲张合并急性血栓性浅表静脉炎

目的：探讨Trivex微创旋切术治疗下肢静脉曲张合并急性血栓性浅表静脉炎的疗效。方法2010年3月～2012年11月对62例血栓性浅静脉炎发病2周内的下肢静脉曲张,在大隐静脉高位结扎和主干剥脱基础上,用Trivex微创旋切系统创吸曲张静脉和静脉丛内的血栓,同时配合加压包扎、术后抗凝等治疗。结果手术均顺利,术中和术后无深静脉血栓及肺栓塞发生。术后局部红肿疼痛于3 d内消退,切口全部甲级愈合。住院时间3～8 d,平均5 d。62例随访2～12个月,平均6个月,大隐静脉曲张、血栓性浅静脉炎治愈无复发,无深静脉血栓形成患者,无死亡。结论 Trivex微创旋切术治疗合并急性血栓性浅静脉炎的下肢静脉曲张安全、有效。     

腔内射频闭合术联合透光直视旋切术治疗下肢静脉曲张的护理

目的 总结腔内射频闭合术联合透光直视旋切术治疗下肢静脉曲张的护理经验.方法 对应用腔内射频闭合术联合透光直视旋切术治疗的392例下肢静脉曲张患者(413条患肢),术前给予心理护理及充分的术前准备,术后给予严密的病情观察和指导以配合治疗.结果 所有患者术后恢复良好,无严重并发症发生.结论 术前充分的准备、术后采取积极有效...     

限制性内翻剥脱联合TriVex旋切及泡沫硬化剂治疗下肢静脉曲张（附132例报告）

目的 探讨限制性内翻剥脱联合TriVex旋切及泡沫硬化剂治疗下肢静脉曲张的手术方法及技巧.方法 2010年2月~2012年2月,应用该方法治疗132例下肢静脉曲张,临床病因病理生理解剖分类系统（CEAP）分级为C2~5 Ep/As/Pr的患者.内翻剥脱大隐静脉主干至膝下水平,小腿曲张静脉团结合透光旋切（transilluminated powered phlebectomy,TIPP）及泡沫硬化剂治疗（foam sclerotherapy）.观察术后瘀斑、隐神经缺失、症状改善情况及术后复发率.结果 所有患者术后下肢静脉曲张消失,临床症状缓解,无严重并发症.术后1个月随访,6.1%（8/132）有隐神经缺失症状.术后1年随访,1.7%（2/117）有隐神经缺失症状.无复发病例.结论 限制性内翻剥脱联合TriVex旋切及泡沫硬化剂治疗下肢静脉曲张简单,微创,有效.     

腔内激光疗法联合透光旋切术治疗大隐静脉曲张的临床疗效

目的 分析腔内激光疗法联合透光旋切术治疗大隐静脉曲张的疗效,总结手术体会,以期取得更好的手术效果.方法 2014年1月-2015年6月,连云港市第二人民医院普外科收治45例大隐静脉曲张患者(共52条肢体),其中男性17例,女性28例;年龄36 ～68岁,单侧肢体病变38例,双下肢病变7例,均行腔内激光疗法联合透光旋切术,并分析其临床疗效.结果 本组患者均顺利完成手术,手术平均时间为(68.4±15.1) min,平均出血量为(23.5±10.7) ml,平均切口数量为(5.8±1.9)个,平均住院时间为(5.9±1.6)d,所有患者均未出现严重并发症.随访12 ～30个月,1例复发.结论 腔内激光疗法联合透光旋切术治疗大隐静脉曲张疗效确切,安全性好,具有手术时间短、术中出血少、术后住院时间短、微创和美观的优点.     

腔内激光、射频及内翻剥脱联合旋切术治疗下肢静脉曲张近期疗效的比较

目的 比较腔内激光、射频及内翻剥脱联合旋切术治疗下肢静脉曲张的近期疗效.方法 回顾性分析2004年6月至2007年1月收治的有明确大隐静脉反流的下肢静脉曲张的460例患者的临床资料,其中200例(232条肢体)采用腔内激光(endovenous laser treatment,EVLT)治疗;80例(88条肢体)采用腔内射频(radiofrequency endovenous occlusion,RFO)治疗;180例(202条肢体)采用内翻剥脱术治疗.曲张静脉均采用透光旋切术(transilluminated powered phlebectomy,TIPP)治疗.比较3种方法手术时间、手术切口、术中出血量、术后住院时间、术后并发症及术后1年时的复发率.结果 手术时问RFO组最长,平均(41±8)min,EVLT组与内翻剥脱组相近.术后住院时间EVLT组(1.2±0.4)d与RFO组(2.1±0.8)d较短,与内翻剥脱组比差异有统计学意义(P＜0.05).术中出血量内翻剥脱组较其他两组多;EVLT组与RFO组的手术切口少;术后1年三组复发率相当,隐神经损伤在内翻剥脱组较多.静脉临床严重程度评分(the venous clinical severity score,VCSS)各组术后较术前明显减少,差异均有统计学意义(P＜0.05).结论 三组手术效果均满意且疗效相当,但激光、射频具有创伤小,并发症少的优点.     

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??Conventional stripping combined with transilluminated powered phlebectomy for lower extremity varicose vein??An analysis of 3170 cases QIAN Song-yi?? LIU Peng??YE Zhi-dong??et al. Department of Cardiac and Vascular Surgery??China-Japan Friendship Hospital??Beijing100029??China
Corresponding author??LIU Peng??E-mail??liupeng5417@163.com
Abstract Objective To summarize operation key points and medium and long-term follow-up results of conventional stripping combined with transilluminated powered phlebectomy for lower extremity varicose vein. Methods The clinical data of 3170 cases (4675 limbs) treated by conventional stripping with transilluminated powered phlebectomy??TIPP??from February 1, 2005 to July 31, 2013 were analyzed retrospectively??The patients were followed up to observe postoperative recovery condition??postoperative complications and postoperative recurrence rate. Results Great saphenous vein trunks was stripped away by conventional stripping technique in all patients and all superficial varicose vein labeled before operation were resected with TIPP. Perforating veins and varicose veins mass in the calf and thigh were divided and ligated respectively according to the labels marked before operation. Surgical time was??62±14??min in unilateral lower extremity and ??97±22??min in bilateral lower extremities. The average hospitalization days was??5.1±1.6??d. Two patients died in perioperative period and perioperative mortality was 0.06%. Total 2747 patients ??3890 lower extremities?? were followed up in 6 to 98 months??and the median follow up time was 47.5 months. The follow-up rate was 86.7% in all patients. Total 2697 patients (3548 lower extremities) had accepted the operation more than 1 year??2265 patients (2877 lower extremities) in which were followed up. There were 133 patients ??4.9%?? recurred ??above C2??. Conclusion Conventional stripping with transilluminated powered phlebectomy for varicose vein of lower limb has the advantages of little trauma??easily operating??definite effect??less complication. The follow-up results suggest that the operation is a surgical procedure with rapid recovery and low recurrence rate.     

TIPP手术治疗下肢静脉曲张临床分析(附59例报告)

目的总结TIPP治疗下肢静脉曲张的临床疗效。方法回顾性分析59例下肢静脉曲张患者(共87条肢体)的临床资料,均行TIPP手术治疗。结果本组59例共87条肢体均顺利完成手术,手术时间平均65(45~100)min,切口数目4~7个。术后出现皮下血肿2例、瘀斑3例、皮下蜂窝织炎1例、痛性硬结3例、足踝部肿胀12例,均采用保守治疗缓解。结论 TIPP治疗下肢静脉曲张创伤小,疗效确切,正确操作可以降低不良反应发生率。     

刨吸术(TriVex)治疗下肢静脉曲张116例临床分析

目的评价TriVex刨吸术治疗下肢静脉曲张的近期治疗效果.方法对116例下肢静脉曲张患者(178条肢体)的曲张浅静脉进行刨吸切除,对手术时间、手术切口、住院时间、并发症及复发率等进行观察.结果每条肢体进行刨吸切除时间为8～45 min,平均24 min;手术切口2～9个,平均4.6个.27条(15.2%)肢体发生局部血肿,2条肢体(1.12%)术后出现小腿蜂窝组织炎,1条(0.56%)术后1个月出现下肢深静脉血栓.116例中有105例(162条肢体)随访3～24个月,平均12.7月,随访率90.5%,复发1例复发率0.62%.结论TriVex刨吸术是治疗下肢静脉曲张的较理想术式.     

Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better?

This study was undertaken to evaluate the evolution of operative vein approaches from combined "open" saphenous stripping-stab avulsion phlebectomy to combined "minimally invasive" endovenous ablation-transilluminated powered phlebectomy with a focus on comparing clinical outcomes. All patients undergoing a combined operative approach for concomitant saphenous vein insufficiency and associated varicose tributary veins between January 1, 1998 and December 31, 2005 were identified. Patients were stratified by operative approach into 3 groups: combined saphenous vein stripping-stab avulsion phlebectomy (STRIP-PHLEB); combined saphenous vein stripping-transilluminated phlebectomy (STRIP-TPP); and combined endovenous ablation-transilluminated phlebectomy (EVAB-TPP). Clinical volume, indications, technical details, and complications were retrospectively reviewed. Over the 8-year period, there were 72 limbs in 59 patients treated with STRIP-PHLEB, 92 limbs in 81 patients with STRIP-TPP, and 99 limbs in 76 patients with EVAB-TPP, with a time-dependent transition in operative techniques noted. There was no difference in distribution of CEAP clinical classification between groups, overall with most limbs in the C2-C4 categories (93.1%) and fewer in the C5-C6 categories (6.9%). There was no difference in overall complication rates between STRIP-PHLEB and EVAB-TPP, although the distribution of complications did shift with a trend toward more wound problems noted in procedures involving saphenous stripping (STRIP-PHLEB 5.6%, STRIP-TPP 6.5%, EVAB-TPP 2.0%; P = NS), and more hematomas in procedures involving transilluminated powered phlebectomy (STRIP-PHLEB 5.6%, STRIP-TPP 16.3%, EVAB-TPP 6.9%; P < .05; see Table 2). Complications associated with the endovenous ablation portion were low including technical inability to cannulate 1.6%, saphenous re-cannulation 2.4%, hematoma 2.4%, severe phlebitis 3.1%, venous thromboembolism 0.8%, and no wound or thermal injury problems. With the shift of combined operative vein approaches for concomitant saphenous vein insufficiency and varicose tributary veins towards "minimally invasive" techniques the overall complication rate has remained unchanged. While combined endovenous ablation-transilluminated phlebectomy offers some advantage of "less" invasiveness, this perceived benefit should be balanced against unchanged overall risk over traditional operative approaches.     

Transilluminated powered phlebectomy in the treatment of varicose veins

Recent trends toward less invasive technologies for treating varicose veins have led to expanding interest in transilluminated powered phlebectomy. Although initial experience with transilluminated powered phlebectomy was variable, with the newer-generation system and modification of technique that allow for slower oscillation speed, higher suction, and extensive tumescence irrigation and drainage, these previous problems have been mostly eliminated. The following report reviews current instrumentation, operative technique, and reported outcomes for transilluminated powered phlebectomy.