高位结扎加腔内激光闭合术治疗大隐静脉曲张156例效果观察

摘要

目的:探讨大隐静脉高位结扎加腔内激光闭合术(EVLT)治疗下肢静脉曲张的效果.方法:我院2007年2月～2008年12月应用EVLT联合治疗156例197条大隐静脉曲张.先于术肢大腿内侧腹股沟韧带下方行2 cm左右的切口结扎大隐静脉主干,再用18G套管针穿刺内踝部位的大隐静脉主干,经套管插入超滑导丝,在超滑导丝的引导下将多用途导丝插入大隐静脉,注入少量肝素氯化钠溶液.而后将光纤插入导管,观察光纤的走行,使用半导体激光仪烧灼曲张血管,同时对烧灼部位加压压迫,完成治疗.结果:本组伤口均1期愈合,术后下肢酸胀沉重感不同程度缓解.随访2～16个月,156例静脉曲张均消失,无严重手术并发症.结论:EVLT治疗大隐静脉曲张,具有微创、安全、疗效好、易于操作的特点,是治疗下肢静脉曲张的优选方法,但本方法应用于临床时间还短,远期疗效有待进一步观察.%Objective:To summarize our experience in treating great saphenous varicose veins with endovenous laser therapy.Methods:156 patients admitted from Feb.2007 to Dec.2008 in our hospital for great saphenous veins were treated by Endovenous Laser Treatment ( EVLT ).197 veins in 156 patients were included in this study.Great saphenous vein was ligated at a 2 cm incision below crural ligament of fem intern and a 18G trochar punctured inner malleolus of great saphenous vein and a super slippery guide wire was inserted into great vein guided by a multi-purpose guide wire.A small amount of heparinate liquid was infused and then an optical fibre was inserted into the catheter.A semiconductor laser was used to cauterize the varicose veins and pressure was given on the cauterized spot.Results:The varicose veins completely disappeared and symptoms and signs were relieved after one treatment in 152 patients .Local recurrence was observed in 3 patients and good results were attained after a laser treatment under local anesthesia.A 2 to 16 month-follow up showed that only one patient needed hospitalization and received repeated therapy.No major complications occurred.Good results were observed at short or medium-term follow ups.Further follow up was needed to assess the long-term results.Conclusion: EVLT for great saphenous varicose veins is minimal invasive,easy to perform,can produce good results and can serve as an important therapy for this kind of disease.Long time follow up is needed to confirm the efficacy.