高位结扎EVLTMuller术治疗C36级原发性-南方医科大学学报.PDF

2010;30(7) 南方医科大学学报(JSouthMedUniv) 窑1709窑 高位结扎+EVLT+Muller 术治疗C3~6 级原发性下肢浅静脉曲张的手术 体会 周忠信袁符方勇袁叶玲袁万恒袁刘正军渊南方医科大学南方医院血管外科袁广东广州510515冤 摘要院 目的 探讨高位结扎+ 腔内激光闭合(EVLT)+muller术治疗C3~6 级原发性下肢浅静脉曲张的手术技巧和疗 效遥 方法术前准确标记曲张静脉袁精细操控导丝袁驱血后高位结扎大隐静脉(GSV)近端袁抬高患肢和压迫下闭合曲张 GSV 主干袁精心设计muller切口的部位和间距遥 结果 95列(146个肢体)手术顺利袁其中2次导丝经小腿交通支进入深 静脉袁1条下肢muller 切口渗血袁8条GSV 主干血栓性静脉炎袁 7 条下肢隐神经热损伤袁1条下肢GSV行程皮肤热损 伤袁2条下肢腹股沟区域血肿袁2条下肢足背凹陷性水肿袁1条下肢muller 切口下脂肪液化袁1条下肢muller 切口线头排 异反应袁均经对症处理后恢复遥术后 140条肢体曲张浅静脉均消失袁4条肢体存在小腿前内侧曲张浅静脉部分残留遥 结 论规范高位结扎+EVLT+muller术的操作流程袁在手术中注意上述操作细节袁可减少并发症遥 关键 院激光曰大隐静脉曰曲张静脉曰并发症 中图分类号院R654 文献标识码院A 文章编号院1673-4254渊2010冤07-1709-03 Experience with endovenous laser treatment combined with high ligation and Mullers phlebectomyforC3-6gradeprimarysuperficialvaricoseinthelowerlimbs ZHOUZhong-Xin,FUFang-yong,YELing,WANHeng,LIUZheng-jun DepartmentofVascularSurgery,NanfangHospital,SouthernMedicalUniversity,Guangzhou510515,China Abstract:ObjectiveTosummarizetheexperiencewithendovenouslasertreatment(EVLT)combinedwithhighligationand Mullersphlebectomyforprimarysuperficialvaricoseinthelowerlimbs. Methods In95patientswithC3-6gradeprimary superficialvaricosein146lowerlimbs, theextentofvaricosewasaccuratelymarked, theguidingwiresweremanipulated precisely, andtheproximalgreatsaphenousveins (GSV) wereligatedafterexsanguinations. ThestemsoftheGSVwere ablatedwithlaserwiththelowerlimbsliftupandpressedhardalongthestems,andMullersincisionswerecarefullyplanned. Results All the operations were completed successfully. The guiding wires entered into the deep veins through the communicatingbranchesin2limbs, 1patientexperiencedcapillaryhemorrhagefromMullersincisions, 8hadthrombotic phlebitisoftheGSV, 7sustainedheat-relatedinjuryofthesaphenousnerves, 1experiencedskinheat-relatedlesion, 2 developedhematomaintheinguinalregion,2hadpittingedemaint