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.

Treatment of varicose veins of lower limb with different surgical methods

Objective To study effects of different surgical methods in the treatment of varicose veins of lower limb. Methods A total of 236 cases of varicose veins (319 lower limbs) were treated from January 1994 to January 2005 with different surgical procedures, including 136 cases of high ligation and stripping of the great saphenous vein (184 limbs), 63 cases of high ligation and stripping combined with subcutaneous continuous circumferential suture-ligation (86 limbs), 7 cases of endovenous laser therapy (9 limbs), and 30 cases of minimally invasive arthroscopic reaming (40 limbs; Two mini-incisions were made on the leg to introduce the arthroscope and reamer respectively, and the varicose veins were removed). Results Follow-up observations were made in 207 cases (87.7%, 275 limbs) for 3~12 months (mean, 10.6 months), involving all the 7 cases of endovenous laser therapy and all the 30 cases of arthroscopic reaming. Postoperatively the sense of soreness and dragging pain and claudication disappeared. Chronic ulcers cleared up at 3~6 postoperative weeks in 125 limbs out of 137 limbs. Mild adverse effects of subcutaneous hematoma or local solid feeling subsided within 3~5 weeks. Conclusions Each of the 4 surgical procedures has its own indications. Minimally invasive arthroscopic reaming is a safe, effective and little invasive novel treatment for varicose veins of lower limb.