腔内激光治疗下肢浅静脉曲张并发症的探讨

The evaluation of complications after endovenous laser treatment for patients with varicose veins of the lower extremities

目的探讨应用腔内激光治疗下肢浅静脉曲张的并发症和预防措施。方法下肢浅静脉曲张患者207例(共268条肢体),男91例,女116例,按照国际静脉联盟CEAP分级,C2:268条肢体,C3:56条肢体,C4:101条肢体,C5:23条肢体,C6:18条肢体。分别采用单纯激光治疗、大隐静脉高位结扎联合激光治疗和股静脉瓣膜包窄术等不同方式治疗,术后对患者进行随访,分析术后并发症。结果随访175例,随访率84．5％,平均随访(10±5)个月,早期并发症包括皮下淤血、青紫178 (66．42％)条肢体,皮肤灼伤56(20．90％)条肢体;中期并发症为有压痛的条索或硬结235(87．69％)条肢体,血栓性浅静脉炎28(10．45％)条肢体,皮肤麻木、疼痛15(5．60％)条肢体。远期并发症包括大隐静脉主干再通4(1．49％)条肢体,曲张静脉残留或复发13(4．85％)条肢体,活动后肢体肿胀6 (2．24％)条。结论腔内激光治疗下肢浅静脉曲张疗效可靠。皮下淤血、青紫以及有压痛的条索或硬结等并发症,多在术后3个月内缓解,规范化手术和大隐静脉高位结扎,能有效减少术后局部曲张静脉复发和大隐静脉主干再通。

Objective To explore causes of complications after endovenous laser treatment （ EVLT）, for patients with superficial varicosities of the lower extremities. Methods In this study, 207 patients with a total of 268 lower limbs were treated by EVLT combined with surgical procedures. According to CEAP classification, there were C2 in 268 limbs, C3 in 56 limbs, C4 in 101, C5 in 23 and C6 in 18. Simple EVLT was performed for 25 limbs in 21 patients; EVLT combined with external banding valvuloplasty of superficial femoral vein for 23 limbs in 23 patients; EVLT combined with ligation of great saphenous vein （GSV） and denudation of superficial varicosities for 220 limbs in 163 patients. Results An average of 10 ±5 （3 ～ 24） months of follow up was achieved in 175 cases. Early complications （within the first 2-weeks after operation） included bruising or ecchymosis （178 cases, 66. 42% ） and skin burning （56, 20. 90% ）. Three month complication included painful induration or trabs （235 cases, 87. 69% ） as well as thrombophlebitis （28, 10. 45% ）. Long-term complication （ after 3 months） included skin numbness or pain at medial knee or ankle region （ 15, 5.60% ）. Recanalization of GSV occurred in 4（ 1.49% ） treated limbs. Residual or reoccurred varicose veins were found in 13 （4. 85% ） cases. Movement related swelling appeared in 6（2.24% ） lower limbs. Conclusion EVLT is effective for patients with superficial varicosities of the lower extremities. Minor complications most often subsided within 3 months. Strict surgical protocol and high ligation of the GSV could prevent local recurrence of the varicose veins and the recanalization of GSV.