大隐静脉高位结扎联合腔内激光闭合和Muller术治疗C4～6级原发性下肢浅静脉曲张及其合并症防治

C4-6 Grade Primary Superficial Varicose of Lower Limbs by EVLT and Muller's Phlebectomy:Therapeutic Strategy and Control of Its Complications

目的探讨大隐静脉高位结扎联合腔内激光闭合(endovenous laser treatment,EVLT)和Muller术治疗C4～6级原发性下肢浅静脉曲张及其并发症的治疗和预防。方法回顾性分析了95列(146条肢体)临床分级C4～6级的下肢浅静脉曲张患者的住院资料。结果95例患者146条下肢顺利完成手术,其中2条下肢发生导丝经小腿交通支进入股深静脉,1条下肢术后当天Muller切口持续渗血,术后8条下肢大隐静脉主干发生血栓性静脉炎,7条下肢出现隐神经热损伤,1条下肢激光损伤大隐静脉行程皮肤,2条下肢术后出现腹股沟区域血肿,2条下肢术后发生足背凹陷性水肿,1条下肢出现Muller切口下脂肪液化,1条下肢出现muller切口线头排异反应。对症处理后上述并发症均消失。结论大隐静脉高位结扎联合EVLT和Muller术治疗C4～6级原发性下肢浅静脉曲张,规范手术流程和注意细节可减少并发症甚杜绝发生严重的并发症的发生。

Objective To explore the therapeutic strategy for C4-6 grade primary superficial varicose of lower limbs by endovenous laser treatment（EVLT） and Muller＇s phlebectomy and control of its complications.Methods There were 95 cases（146 lower limbs） received the procedures of EVLT and Muller＇s phlebectomy,and their data of hospitalization were analyzed retrospectively.ResultsAll patients had operations successfully,among which guide wire entered deep femoral veins through communicating branches in 2 limbs,one experienced lasting capillary hemorrhage from Muller＇s incision,8 cases complicated with thrombotic phlebitis in stems of great saphenous veins,7 cases complicated heat-related casualty of saphenous nerves,one experienced skin damage along great saphenous vein,2 cases happened hematoma in inguinal region,2 cases happened pitting edema in dorsum of foot,one appeared fat liquefaction of Muller＇s incision,and one happened rejection of thrum in Muller＇s incision.After conservative treatment,all recovered and discharged.ConclusionsIt is necessary to manipulate in routine and watch out operation details in EVLT and Muller＇s phlebectomy to treat severe primary superficial varicose of lower limbs.