射频闭合联合动力旋切治疗下肢静脉曲张

Combinative Use of Radiofrequency and Transilluminated Powered Phlebectomy in Treatment of Varicose Veins of Lower Extremity

目的探讨射频闭合联合动力旋切治疗下肢静脉曲张的效果和安全性。方法将321例下肢静脉曲张患者分为3组:微创治疗A组102例(129条患肢),用射频行大隐静脉全程原位闭合,小腿曲张静脉用动力旋切;微创治疗B组97例(126条患肢),用射频行大隐静脉大腿段原位闭合,小腿曲张静脉及小腿段大隐静脉主干用动力旋切;传统治疗组122例(142条患肢),行传统手术作对照,即大隐静脉高位结扎、抽剥,属支及交通支切除、结扎。观察3组术后治疗效果及并发症发生情况。结果下肢肿胀、下肢乏力症状改善率,术后1周,微创治疗A、B组均高于传统治疗组(P<0.05);术后1个月,3组间各项临床症状改善情况比较,差异均无统计学意义(P>0.05)。术后小腿皮肤麻木、大腿瘀斑、创口血肿以及踝以下肿胀发生率比较,微创治疗A、B组明显低于传统治疗组(P<0.05);小腿瘀斑发生率,微创治疗A组明显低于传统治疗组(P<0.05),微创治疗B组与传统治疗组比较差异无统计学意义(P>0.05)。本组病例无下肢深静脉血栓形成和切口感染的发生。结论射频闭合联合动力旋切治疗下肢静脉曲张,简单可行,疗效确切。动力旋切去除静脉团效果好,但可能不适于旋切大隐静脉主干。

Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups： group A （102 cases） ： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B （97 cases）： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebeetomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group （group C）. Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.