腔内激光联合泡沫硬化剂治疗下肢静脉性溃疡的疗效分析

Effectiveness of endovenous laser combined with foam sclerosing agent for venous ulcer of lower extremities

目的探讨腔内激光消融术联合泡沫硬化剂治疗腿部静脉性溃疡的疗效和安全性。方法回顾性分析行大隐静脉主干激光闭合术+曲张静脉及穿通支硬化剂注射术的41例(43条肢体)下肢静脉性溃疡患者的资料。对大隐静脉及其分支静脉、穿通支闭合情况、溃疡恢复情况、皮下血肿等并发症的发生情况进行分析,以评价该术式的疗效。结果 41例患者(43条肢体)手术均成功,手术时间15～50分钟,平均(38.90±8.45)分钟,住院时间7～29天,平均住院时间(15.06±7.85)天。40例患者下肢溃疡愈合,愈合时间平均为(28.24±10.44)天,1例患者因溃疡面积较大,术后待肉芽新鲜后给予植皮手术,溃疡愈合。平均每条肢体用15(7～27)ml泡沫硬化剂,术后发生皮下血肿6例,1例术后一过性呼吸困难,给予对症处理后均缓解,无严重并发症发生。术后随访6个月,溃疡均未复发。结论腔内激光闭合反流的大隐静脉主干联合泡沫硬化剂阻塞曲张浅静脉、穿通支,用于治疗静脉性溃疡是有效的、安全的。

Objective To evaluate the efficacy and safety of endovenous laser ablation(EVLA)combined with foam sclerotherapy in the treatment of the venous ulcer of lower extremity(VULE). Methods Retrospective analysis of 41 patients(43 limbs) with VULE who underwent laser closure of great saphenous vein combined with sclerosing injection of varicose veins and perforating branches. Closure of great saphenous vein, branch vein and perforating branch, ulcer recovery and complications such as subcutaneous hematoma were analyzed to evaluate the effect of the operation. Results 41 patients(43 limbs) were operated successfully. The average operation time was 15 ~50 minutes, the average operation time was(38.90 ±8.45) minutes, the hospitalization time was 7 ~29 days, and the average hospitalization time was(15.06±7.85) days. 40 patients had lower limb ulcer healing, and the average healing time was(28.24±10.44) days. One patient whose ulcer area was too large waited for fresh granulation before skin transplantation, and finally the ulcer healed. On the average, 15(7~27) ml foam sclerosing agent was used for each limb. Subcutaneous hematoma occurred in 6 patients after operation, postoperative dyspnea occurred in1 patient, and all of them were relieved after symptomatic treatment No severe complications occurred. No ulcer recurred After a 6-month follow-up. Conclusion Intracavitary laser closed reflux of the great saphenous vein main stem combined with foam sclerosing agent to block varicose veins and perforating branches is effective and safe for the treatment of venous ulcers.