保留上段主干的激光闭合术在大隐静脉曲张治疗中的应用

Endo-venous laser ablation with reservation of proximal segment in treating greater saphenous varicoses

目的:讨论保留上段主干的腔内激光闭合术(endo-venous laserablation,EVLA)在大隐静脉曲张治疗中的应用。方法:自2009年1月至2009年12月收治我科的大隐静脉曲张病例,经术前光电容积描记和多普勒超声检查确定隐股静脉瓣膜无返流且大隐静脉根部直径≤8 mm共63例(71条肢体),分成保留组35例(38条肢体)和非保留组28例(33条肢体),分别实施与否保留大隐静脉上段主干的EVLA。取两组的Aberdeen评分改善值,手术时间,住院天数,1年复发率和手术并发症率进行比较。结果:保留组的手术时间短于非保留组(17.5±4.3 min比22.7±5.6min,P<0.01):保留组的隐神经损伤者少于非保留组(2/38比4/33,P<0.05);两组的Aberdeen评分改善值和住院天数基本相当,出现皮下硬结、瘀斑、组织灼伤等并发症的概率在两组间差异无统计学意义,两组病例均无肺栓塞等严重并发症出现。保留组上段主干1年通畅率100%,保留组和非保留组的1年复发率分别为3%和4%。结论:保留大隐静脉上段主干的激光腔内闭合术是微创治疗大隐静脉曲张的安全、有效方法。

Objective Whether the trunk of the greater saphenous vein could be reserved in the treatment of varicoses,is to be discussed in our study.Methods All of the venous varicoses cases,who had been admitted in our department during Jan 2009 to Dec 2009,were persuaded to join the study.When ultrasonograph excluded the existence of sapheno-femoral reflux,and the diameter of the root of the vessel≤8 mm,a total of 63 cases（71 limbs） were obtained to enter the study;they were randomized into：①the saphenous-reserved group（35 cases,38 limbs） and②the non-reserved group（28 cases,33 limbs）.In group 1,endo-venous laser ablation（EVLA） was employed.The Aberdeen score, operative time,rate of complication and 1-year-rate of recurrence were observed.Results The operative time in group 1 was less than that of group 2（17.5±4.3 min vs 22.7±5.6 min,P0.01）;the Aberdeen score,hospital stay and rate of main complications were similar in both groups.However,the rate of saphenous nerve injury was less often in group 1.No pulmonary embolism was seen in the study.Conclusions Saphenous-reserved EVLA is a safe,effective and minimally invasive treatment for chronic greater saphenous vein efficiency.