下肢慢性静脉功能不全微创治疗探讨.docVIP

下肢慢性静脉功能不全微创治疗探讨 　　[摘要] 目的 探讨浅静脉高位结扎腔内激光闭合小切口筋膜下交通支离断术微创治疗下肢慢性静脉功能不全的临床疗效。方法 对28例下肢慢性静脉功能不全患者36条肢体,采用浅静脉高位结扎、主干及分支腔内激光闭合、深静瓣膜功能不全Ⅳ级者一期行瓣膜外缩窄、二切口小腿交通支深筋膜下离断术进行微创治疗。结果 1例行深静脉瓣膜外缩窄术者术后早期发生深静脉血栓形成,小腿溃疡在术后1年复发,对症治疗后稳定。其余患者患肢临床症状改善,切口及溃疡在2周-2月内愈合。结论 浅静脉高位结扎腔内激光闭合深静脉瓣膜外缩窄联合二切口筋膜下交通支离断微创治疗下肢慢性静脉功能不全,具有微创美观、经济安全、操作简单、疗效确切的优点。 　　[关键词] 静脉曲张;激光;交通支 　　[中图分类号] R543.6[文献标识码]A [文章编号] 　　 　　Discussion of the minimal invasive treatment in chronic venous insufficiency of lower extremity Zhu Zhaohong , Wang Hai,Department of General Surgerg,The Hospital of Huaibei,Anhui 235000 　　[Abstract]Objective To explore the clinical effect of high ligation,endovenous lser and cut of perforating vein mutilation through little incision in treating chronic venous insufficiency(CVI)of lower extremity.Methods Twenty-eight patients(36 limbs)of CVI received high ligation and endovenous laser of trunk and branch.The patients With Grade IV CVI had secondary valve narrowing and perforating vein cut through little incision.Results One case had deep thrombosis and ulcer recurred one year after operation.The remaining 36 cases recovered in 2 weeks-2months,the symptoms of all cases improved.Conclusion High ligation of superficial veins,endovenous laser,deep venous valve narrowing and perforating veins cut mutilation in treating CVI is worth to spread because of minimal invasiveness,simplicity,safety and effectivity. 　　[key words] varicose venous;Laser;perforating Vein 　　 　　下肢慢性静脉功能不全(chronic venous insufficiency,CVI)临床最多见的病变是单纯性下肢浅静脉曲张和原发性深静脉瓣膜功能不全,二者往往同时合并存在下肢交通支静脉 功能障碍[1]。外科治疗传统的手术方式包括下肢浅静脉高位结扎及抽剥术、深静脉瓣膜功能重建术和交通支静脉结扎术。近年来,随着微创技术的临床???用,CVI微创治疗也得到了较快发展。我院2003年3月-2008年10月,应用小切口浅静脉高位结扎静脉腔内激光(EVLT)联合小切口筋膜下交通支离断术微创治疗CVI28例36条肢体,总结报道如下。 　　1 临床资料 　　1.1一般资料 　　本组患者男22例,女6例。年龄36-78岁,平均 57岁。28例36条肢体中左下肢17肢、右下肢3肢、双下肢8例16肢。病史18月-15年。36条肢体中单纯性下肢浅静脉曲张合并小腿交通支功能不全14肢(38.9%),原发性深静脉瓣膜功能不全合并小腿交通支功能不全22肢(61.2%),其中深静脉瓣膜功能不全Ⅱ级13肢、Ш级6肢、Ⅳ级3肢。所有病例均经下肢彩色超声和下肢静脉顺行造影检查证实。临床均以小腿酸胀沉重乏力为主诉,以小腿以下尤以远端肿胀皮肤张力增高浅静脉不同程度曲屈凸起为主要表现,膝以上浅