下肢静脉曲张的外科综合治疗

Surgical Treatment for Varicose Vein

目的探讨下肢静脉曲张外科综合治疗的方法及疗效。方法回顾性分析了2000年7月-2006年1月在我院就诊的2200例下肢静脉曲张患者外科手术治疗的资料，其中1802例患者采用激光联合透光直视旋切术；82例采用射频联合透光直视旋切术；218例采用选择性内翻式大隐静脉剥脱联合硬化剂治疗或透光直视旋切术；98例分别采用激光、高位结扎、射频处理大隐静脉主干，辅以曲张静脉团的手术切除、激光、电凝、皮下连续缝扎或硬化剂注射方法治疗。对于伴有交通支功能不全的患者，术中结扎或切断交通支；对于严重深静脉瓣功能不全的患者，同时处理深静脉瓣。结果所有患者术后大隐静脉返流消失，静脉曲张消失，均临床治愈，手术时间为20—78min，平均40min。结论激光、射频、内翻剥脱是治疗大隐静脉返流的有效方法。手术切除、皮下连续逢扎、电凝（分支）、硬化剂注射对静脉团的处理有很好的效果。切断结扎返流的交通支十分重要。透光直视旋切术对静脉团的处理十分理想，治疗彻底，但需注意操作方法。

Objective To explore the techniques and outcomes of the surgical treatment for varicose vein. Methods Totally 2 200 patients with varicose vein received surgical treatment in our hospital from July 2000 to January 2006. The latest techniques for 1 802 cases were treated with endovenous laser phlebectomy （TIPP） , 82 cases with radiofreque endovenous occlusion were used for most cases, among which treatment （EVLT） combined with transiUuminated powered ncy endovenous occlusion （RFO） combined with TIPP, and 218 cases with limited invaginated vein stripping and foam sclerotherapy. The remaining 98 cases were treated with laser, radiofrequency or ligation for saphenous vein trunk, and with resection, electric coagulation, and transfixation for vein clusters as additional methods. Perforators were also cutted and ligated as well. Results Satisfied surgical results were obtained in all cases. The average operative time was 40 minutes （ range 20-78 minutes）. Conclusions Limited invaginated vein stripping, EVLT, and RFO can be used to treat saphneous vein reflux. Surgical resection, transfixation, electric coagulation, and sclerotherapy are reasonal options for vein cluster or tributaries. Transection and ligation of the perforators are important. TIPP is ideal for the treatment of vein clusters.