下肢静脉曲张疾病腔内激光治疗并发症的防治

Prevention and treatment of complications of endovenous laser therapy for varicose venous diseases of lower limbs

目的探讨激光治疗下肢静脉曲张疾病的并发症原因及防治方法。方法回顾性分析420例（525条肢体）下肢大隐静脉曲张患者的临床资料。其中单纯性大隐静脉曲张324例（422条肢体），下肢深静脉瓣膜功能不全96例（103条肢体）。采用单纯激光治疗263条肢体，激光加小切口静脉团点状剥脱159条肢体，激光治疗联合股浅静脉戴戒术25条肢体和激光加小切口静脉团点状剥脱联合股浅静脉戴戒术78条肢体。结果有331条肢体（占63．1％）术后出现与激光治疗有关的并发症，其包括：皮下淤斑268条肢体（占51．1％），隐神经损伤198条（占37．7％），腿部皮下血栓性静脉炎33条（占6．3％），小腿轻度皮肤灼伤26条（占5，0％）。全组无切口感染发生，无术后深静脉血栓形成的病例。术后380例（90，5％）获随访3～40个月，单纯性大隐静脉曲张者术后有27条肢体复发（复发率6．4％），下肢深静脉瓣膜功能不全者术后有8条肢体复发（复发率7．8％）。结论在应用激光治疗下肢静脉曲张疾病过程中应重视对其并发症的预防和治疗，以充分体现激光治疗安全和微创的特点。

Objective To explore the causes of complications of varicose venous diseases of lower limbs treated by endovenous laser and methods of prevention and treatment. Methods Clinical materials of laser treatment of 420 patients （ 525 limbs ） with greater saphenous vein （ GSV ） varices were studied retrospectively. Of them, 324 cases（422 limbs） were simple GSV varicosis, and 96 cases （103 limbs） coexistented primary deep venous insufficiency（ PDVI ） of lower limbs. There were 263 limbs treated with laser therapy only, 159 limbs treated with laser combined with stab-avulsion of venectasias in the calf , 25 limbs treated with laser and insertion of superficial femoral vein ring and 78 limbs treated with laser and stab-avulsion of venectasias combined with insertion of superficial femoral vein ring. Results Complications related to laser therapy occurred in 331 limbs （ 63. 1% ） , which consisted of skin petechiae in 268 limbs （ 51. 1% ） , saphenous nerve injury in 198 （ 37. 7 % ） , superficial thrombophlebitis in 33 （ 6. 3 % ） and mild skin bum in 26 （5.0 % ）. There were no patients with infected incisions or deep venous thrombosis of the lower limbs. In this group, 380 patients （90. 5% ） were followed-up from 3 to 40 months postoperatively. Postoperative recurrence were diagnosed in 27 limbs （ 6.4 % ） with simple GSV varicosis and in 8 limbs （ 7. 8 % ） with PDVI. Conclusions The prevention and treatment of the complications caused by laser therapy should be highly kept in mind, so as to express the safe and micro-traumatic features of the endovenous laser for treatment of varicose venous diseases of lower limb.