下肢深静脉瓣膜功能不全激光微创综合治疗10年以上长期随访观察

Ten Years' Long-Term Follow-up Study on Patients of Primary Deep Venous Insufficiency Given Comprehensive Minitraumatic Laser Treatment

目的观察微切口瓣膜修复联合血管内激光光凝治疗原发性下肢深静脉瓣膜功能不全的10年以上远期疗效,探讨激光微创综合治疗下肢深静脉瓣膜功能不全的临床经验。方法回顾性总结2001~2007年,收治的下肢深静脉瓣膜功能不全患者1 049例临床资料,包括原发性下肢深静脉瓣膜功能不全肢体1 159条。硬膜外麻醉取股部微小切口,第一对股浅静脉瓣膜外修复;以波长810 nm半导体激光对迂曲扩张的浅静脉进行血管内光凝术。手术后每年进行随访观察,利用超声多普勒确认治疗后的浅静脉是否闭合、深静脉是否反流。结果术后恢复顺利,微切口愈合良好,曲张静脉消失、溃疡愈合,无深静脉血栓形成、淋巴漏等严重并发症。术后6个月检查评估,临床治愈98.9%。全部病例获得10年以上连续随访,术后1年治愈率98.0%,5年治愈率94.9%,8年治愈率92.9%,10年治愈率为91.3%,15年治愈率81.7%。术后5年、10年下肢出现明显浅静脉迂曲扩张者7例和11例,采用多点穿刺植入光纤激光光凝治疗,对网状扩张的血管辅以硬化剂治疗,均治愈。结论激光微创综合治疗原发性下肢深静脉瓣膜功能不全是一种较好的微创治疗方法,效果稳定,10年以上远期疗效好。

Objective To observe the long-term effect to treat primary deep venous valve insufficiency in lower extremities jointly with micro-inci- sion valve repair and intravascular laser photocoagulation and broaden the clinical experience of comprehensive and minimally-invasive laser therapy for deep venous valve insufficiency. Methods A retrospective summary was made on the clinical data of 1 049 patients during the period from 2001 to 2007, including the information on 1 159 limbs with primary deep venous valve insufficiency. All these patients were given the operation of the superficial femoral valvular repair with 3cm micro-incision and the superficial varicosity endovascular laser photocoagulation with 810 nm laser semiconductor. A follow-up was performed each year after the operation. The clinic manifestations were recorded and the Doppler ultra- sonic examinations were done to confirm whether the operated superficial veins were closed and whether reflux occurred to the treated deep veins again. Results The postoperative recovery was successful, the micro-incision healed well, the varicose veins disappeared and the venous ul- cers were cured. Neither deep venous thrombosis nor other serious complications were observed. All the cases were followed up for more than 10 years. The cure rates for 1, 5, 8, 10 and 15 years were 98.0%, 94. 9%, 92. 9%, 91.3% and 81.7% respectively. Superficial venous＇. varicosity occurred to 7 and 11 patients respectively 5 and 10 years after the operation, which were cured with the endovascular laser photocoagulation relying on multipoint puncture. Conclusions Combining micro-incision valve repair and intravascular laser photocoagulation is a desirable minimally-invasive treat- ment for primary deep venous valve insufficiency and its has good and stable long-term effect for over a decade.