冷光源引导下泡沫硬化剂注射小腿曲张浅静脉在下肢静脉溃疡治疗中的应用探讨

Clinical efficacy of cold light source-guided foam sclerotherapy with lauromacrogol for venous ulcer of the lower extremities

目的探讨冷光源引导下泡沫硬化剂注射小腿曲张浅静脉联合腔镜深筋膜下交通支静脉离断术（SEPS）及大隐静脉高位结扎抽剥术治疗下肢交通静脉功能不全所致的静脉溃疡中的作用效果。方法选取2012年6月至2013年5月就诊的42例（46条患肢）小腿交通静脉功能不全合并浅静脉曲张的静脉溃疡患者，行SEPS术及大隐静脉高位结扎抽剥术，并在SEPS术的冷光源引导下行小腿曲张静脉泡沫硬化剂注射术。结果共注射263条曲张浅表静脉。随访期间所有患者静脉溃疡均愈合。9例患者的9条下肢（9／46，19．57％）在术后4周内出现局部疼痛，口服止疼药可缓解。22例患者的24条下肢（24／46，52．17％）共46条静脉（46／263，17．49％）在术后1～2周出现沿治疗曲张静脉行程的黄褐色色素沉着，于3—6个月内自行消失。3例患者3条下肢（3／46，6．52％）共11条静脉（11／263，4．18％）在治疗后1周出现沿曲张静脉分布的红、热、痛和压痛，诊断为浅表性静脉炎，外用多磺酸黏多糖乳膏后缓解。经过注射的263条曲张静脉中，245条（245／263，93．16％）达到治疗成功标准，18条（18／263，6．84％）达到部分成功标准，无一条静脉未成功注射。结论冷光源引导下的小腿曲张静脉泡沫硬化剂注射联合SEPS术及大隐静脉高位结扎抽剥术是良好的治疗交通静脉功能不全所致静脉溃疡的方法，其长期作用效果有待进一步观察。

Objective To observe the clinical efficacy of cold light source-guided foam sclerotherapy with lauromacrogol combining subfascial endoscopic perforator surgery （SEPS） and long saphenous vein flush ligation and stripping for venous ulcer of the lower extremities. Methods From June 2012 to May 2013, forty-two patients with forty-six lower limbs of venous ulcer induced by incompetent perforator veins were treated. All the patients were performed SEPS, long saphenous vein flush ligation and stripping, and cold light source-guided foam sclerotherapy with lauromacrogol. Results Foam was injected to 263 veins by cold light-guided source. All venous ulcers were found recovered from a 3- to 12-month followed up. Nine patients felt pain in lower limbs and were given painkillers. Forty-six veins（17.49%） of 22 patients showed pigmentation following the varicosities one to two weeks after surgery. It disappeared in 3-6 months. Eleven veins （4.18%） of 3 lower extremities （6.52%） of 3 patients with varicosities demonstrated phlebitis and recovered after using Hirudoid. Two hundred and forty-five veins（93.16%） of treated varicosities achieved complete success criteria; the other 18 veins （6.84%） achieved partial success criteria. Conclusion Cold light source-guided foam sclerotherapy with lauromacrogol combining SEPS and long saphenous vein flush ligation and stripping is a good method to treat venous ulcer of the lower extremities, while the long-term effects need observing.