腔内激光闭塞联合透光直视刨吸术治疗原发性浅静脉曲张

Clinical effects of endovenous laser therapy plus transilluminated powered phlebectomy in treatment of primary varicose veins

目的评估静脉腔内激光闭塞联合透光直视刨吸术对原发性浅静脉曲张的临床疗效。方法对82例患者105条原发性浅静脉曲张肢体施行腔内激光闭塞和透光直视刨吸术联合治疗,从手术相关指标、术后并发症、术后静脉功能和患者生活质量改善情况等方面对于术效果进行综合评价。结果腔内激光闭塞术治疗成功率98.1%(103/105),透光直视刨吸术成功率100%(105/105)。平均手术时间为53.8min(35～108min),平均手术伤口为4.4个(3～7个),平均术后住院时间4.8d(2～6d)。术后3、6、12个月随访率分别为100%(82/82),93.9%(77/82)和35.4%(29/82),术后3个月所有患肢症状均明显减轻或完全消失。光电体积描记检查发现 VFI、EF、RVF 与术前比较差异无统计学意义(P<0.01),术后3、6、12个月上述指标与术后1个月比较,差异无统计学意义(P>0.05)。Aberdeen 静脉曲张问卷(AVVQ)和疾病严重程度评分(VCSS)手术前后比较有显著性差异(P=0.000),患者对术后肢体外观满意程度达91.5%。结论腔内激光闭塞联合透光直视刨吸术是治疗原发性浅静脉曲张的有效方法,具有满意的美容效果。

Objective To evaluate the clinical and cosmetic effects of endovenous laser therapy （EVLT） plus transilluminated powered phlebectomy （TIPP） in the treatment of primary varicose veins. Methods The clinical effects of EVLT plus TIPP in treatment of 82 patients of primary varicose vein with 105 extremities were evaluated. The procedure-related parameters, clinical outcomes, and complications were recorded. The venous function was assessed by venous photoelectric plethysmography （VPPG）. Aberdeen Varicose Veins Questionnaire （AVVQ） and Venous Clinical Severity Score （VCSS）surveys were used to appraise the quality of life and symptomatic alleviation. Results The successful rates of EVLT and TIPP was 98.1% （103/105） and 100% （105/105） respectively. The average operating time was 53.8 rain （35 N 108 rain）. The average number of wounds was 4.4 （3 N 7）. The postoperative hospitalization time was 4.8 d （2 -6 d）. The follow-up rates 3, 6, and 12 months after operation were 100% , 93.9%, and 35.4% respectively. Obvious symptom alleviation or entire disappearance was noticed in all the limbs 3 months after operation. The hemodynamic parameters, such as venous filling index （VFI） , ejection fraction （EF）, and residual volume fraction （RVF） were significantly ameliorated 1 month after the operation compared with those measured preoperatively （ all P 〈 0.01 ）. No further improvements were noticed from then on （ P 〉 0.05 ）. Disease specific quality of life was greatly improved after operation （ P = 0. 000 ）. 91.5% of the patients were satisfied with the postoperative appearance of the involved limbs. Conclusion EVLT plus TIPP is an efficacious minimally invasive strategy for the treatment of primary varicose veins, resulting in approving cosmetic effect as well.