血管腔内激光术治疗下肢静脉曲张的临床应用研究
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摘要
目的 观察血管腔内激光术治疗下肢静脉曲张的临床疗效并初步探讨其作用机理。方法 78例单纯性下肢静脉曲张患者或原发性下肢深静脉瓣膜功能不全并浅静脉曲张患者随机分为治疗组35例(40条患肢)和对照组43例(44条患肢)，治疗组以血管腔内激光术治疗，对照组以传统的大隐静脉高位结扎、分段剥脱及交通支结扎术治疗。观察两组患者术前、术后的一般情况、症状体征的变化以及术后并发症，同时观察治疗组术前、术后的多普勒检查、病理检查结果。结果 与对照组相比较，激光治疗术能明显减少手术时间、术后肢体疼痛时间及住院天数，两者有显著性差异(P＜0.01)，治疗组患者术后恢复快；并发症：皮下血肿、患肢皮肤感觉麻木及切口愈合率治疗组均明显优于对照组，两者有显著性差异(P＜0.05，P＜0.01)；对于患者症状体征的改善两组无显著性差异(P＞0.05)；治疗组术后的病理检查结果显示激光治疗术后的静脉内、中、外膜的变性、坏死，无炎性细胞浸润；多普勒检查显示40例(100％)大隐静脉主干内均无血流显示，其直径平均较术前缩小27.16％，仅3例(7.50％)发现分支静脉中有缓慢线状血流信号。结论 血管腔内激光术是一种近期疗效良好的手术方法，具用微创、并发症少、患者恢复快等优点，其作用原理是通过光热作用利用激光转化产生的热能破坏静脉壁，使其达到纤维化，管腔闭塞，从而达到治疗目的。
Objective To observe the clinical effect of EndoVenous Laser Treatment for lower extremity varicose veins and study its therapeutic mechanism, introduce a new operative method. Methods seventy-eight patients of lower extremity varicose veins were divided randomly into therapy group (35 cases, 40 legs) and control group (43 cases, 44 legs). The therapeutic group was received endovenous laser treatment and the control group was given surgical ligation and stripping . The changes of clinical symptoms in all patients were observed before and after treatment. In additional, we observed the changes of Doppler examination and veins' pathology of the EVLT group. Results The patients of the therapeutic group recovered more quickly and the side effects were less than the control group. These changes were statistically different compared with those of the control group, P<0. 05, P<0.01. The two groups' effects on improving the symptoms were not different. The changes were statistically identical, P>0.05. The pathology' s variation was retrogression and necrosis of the wall of the veins, and there were no inflammatory cell infiltrating. The results of the Doppler examination after treatment showed the GSVs were all closed (100%), and the GSVs' mean diameter reduced 27. 16%. Furthermore, we discovered prosodemic flood flow in ramose veins in 3 cases (7.50%). Conclusion The endovenous laser treatment appears to be a new method with good short-term results. The EVLT has advantages of
minimal invasion, less side effects and less time of the patients' recovery. Its therapeutic mechanism is utilizing the heat emitted by the laser sight to destroy the wall of the veins. The veins are gradually fibroid and close at last. But the long-term follow-up is awaited.
Objective To observe the clinical effect of EndoVenous Laser Treatment for lower extremity varicose veins and study its therapeutic mechanism, introduce a new operative method. Methods seventy-eight patients of lower extremity varicose veins were divided randomly into therapy group (35 cases, 40 legs) and control group (43 cases, 44 legs). The therapeutic group was received endovenous laser treatment and the control group was given surgical ligation and stripping . The changes of clinical symptoms in all patients were observed before and after treatment. In additional, we observed the changes of Doppler examination and veins' pathology of the EVLT group. Results The patients of the therapeutic group recovered more quickly and the side effects were less than the control group. These changes were statistically different compared with those of the control group, P<0. 05, P<0.01. The two groups' effects on improving the symptoms were not different. The changes were statistically identical, P>0.05. The pathology' s variation was retrogression and necrosis of the wall of the veins, and there were no inflammatory cell infiltrating. The results of the Doppler examination after treatment showed the GSVs were all closed (100%), and the GSVs' mean diameter reduced 27. 16%. Furthermore, we discovered prosodemic flood flow in ramose veins in 3 cases (7.50%). Conclusion The endovenous laser treatment appears to be a new method with good short-term results. The EVLT has advantages of
minimal invasion, less side effects and less time of the patients' recovery. Its therapeutic mechanism is utilizing the heat emitted by the laser sight to destroy the wall of the veins. The veins are gradually fibroid and close at last. But the long-term follow-up is awaited.
引文
[1]王深明，陈国锐，林勇杰，等．经皮浅静脉连续环形缝扎术治疗下肢静脉曲张．中国实用外科杂志，1998；18(5)：292．
[2]吴在德．外科学，北京；人民卫生出版社，2001，5：686．
[3]王深明，陈国锐，林勇杰，等．经皮浅静脉连续环形缝扎术治疗下肢静脉曲张．中国实用外科杂志，1998；18(5)：292．
[4]裴玉崑．周围血管病学，北京；北京科学技术出版社，1993，1：264．
[5]裴玉崑．周围血管病学，北京；北京科学技术出版社，1993，1：264．
[6]尚德俊，侯玉芬，陈柏楠．周围静脉疾病学，北京；人民军医出版社，2001，1：78．
[7]曾良驹，曾弢．辨证分型治疗下肢静脉曲张64例．四川中医，200；18(10)：44．
[8]盖世昌．大黄(庶虫)虫丸治疗下肢静脉曲张并发症和后遗症的探讨．中医药学报，1987；2(1)：34．
[9]李墨峰．筋骨痛消丸为主治疗下肢静脉曲张56例报道．中医正骨，1998；10(4)：40．
[10]陈柏楠，侯玉芬，周涛．周围血管疾病中西医诊疗学，北京；中国中医药出版社，1999，1：467．
[11]张东萍，何立纲，崔公让．下肢静脉曲张病因及治疗方法研究进展．中国中西医结合外科杂志，2002；8(1)：59．
[12]陆平，夏广志．实用外科学，沈阳；辽宁科学技术出版社，1999，1：530．
[13]陈永健．枯痔钉治疗内痔及其机理探讨．中华外科杂志，1981；19(2)：82．
[14]徐泉，李恭才，张宪生，等．尿素注射疗法治疗下肢静脉曲张的临床研究．中国普通外科杂志，1996；2(5)：97．
[15]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[16]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[17]HANXiaojun, LIZhengwei, ZHUChanghong. Applica-tionSemiconductorLaserinMe dical. OPTICTECHNOLO-GY. 1998: (2): 7(in Chinese).
[18]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[19]朱枬，曾绍群，骆清铭，等．激光与生物组织相互作用：光子迁移与生物传热理论．激光生物学报，2000，9(1)：68．
[20]Luis Navarro, Robert J. Min, Carlos Bone. Endovenous Laser: A New Minimally Invasive Method of Treatment for Varicose Veins-Preliminary Observations Using an 810 nm Diode Laser. Dermatol Surg, 2001; 27: 117.
[21]Mathewson K. Lowpowerlaser hyperthermia. In: Krasner N(ed): Lasers in Gastroenterology. London, Chapman &Hall Medical, 1991; 281.
[22]Robert J. Min, MD, Steven E. Zimmet, MD, Mark N, et al. Endovenous Laser Treatment of the Incompetent Great Saphenous Vein. Vascular and Interventional Radiology, 2001; 10(12), 1167.
[23]王嘉桔，张静菊．下肢静脉曲张加压硬化剂疗法的有关问题．普通外科杂志，1999；6(14)：461．
[24]Kister RL, Ekolof B, Masuda EM. Deep venous valve reconstruction. Cardio vascular Surg, 1995; 3(2): 129.
[25]吴丹明，董齐，易巍，等．电凝术治疗下肢静脉曲张27例临床分析．中国实用外科杂志，2002；22(2)：99．
[2]吴在德．外科学，北京；人民卫生出版社，2001，5：686．
[3]王深明，陈国锐，林勇杰，等．经皮浅静脉连续环形缝扎术治疗下肢静脉曲张．中国实用外科杂志，1998；18(5)：292．
[4]裴玉崑．周围血管病学，北京；北京科学技术出版社，1993，1：264．
[5]裴玉崑．周围血管病学，北京；北京科学技术出版社，1993，1：264．
[6]尚德俊，侯玉芬，陈柏楠．周围静脉疾病学，北京；人民军医出版社，2001，1：78．
[7]曾良驹，曾弢．辨证分型治疗下肢静脉曲张64例．四川中医，200；18(10)：44．
[8]盖世昌．大黄(庶虫)虫丸治疗下肢静脉曲张并发症和后遗症的探讨．中医药学报，1987；2(1)：34．
[9]李墨峰．筋骨痛消丸为主治疗下肢静脉曲张56例报道．中医正骨，1998；10(4)：40．
[10]陈柏楠，侯玉芬，周涛．周围血管疾病中西医诊疗学，北京；中国中医药出版社，1999，1：467．
[11]张东萍，何立纲，崔公让．下肢静脉曲张病因及治疗方法研究进展．中国中西医结合外科杂志，2002；8(1)：59．
[12]陆平，夏广志．实用外科学，沈阳；辽宁科学技术出版社，1999，1：530．
[13]陈永健．枯痔钉治疗内痔及其机理探讨．中华外科杂志，1981；19(2)：82．
[14]徐泉，李恭才，张宪生，等．尿素注射疗法治疗下肢静脉曲张的临床研究．中国普通外科杂志，1996；2(5)：97．
[15]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[16]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[17]HANXiaojun, LIZhengwei, ZHUChanghong. Applica-tionSemiconductorLaserinMe dical. OPTICTECHNOLO-GY. 1998: (2): 7(in Chinese).
[18]姚翠萍，张镇西．激光与组织的相互作用．激光生物学报，1999，8(2)：102．
[19]朱枬，曾绍群，骆清铭，等．激光与生物组织相互作用：光子迁移与生物传热理论．激光生物学报，2000，9(1)：68．
[20]Luis Navarro, Robert J. Min, Carlos Bone. Endovenous Laser: A New Minimally Invasive Method of Treatment for Varicose Veins-Preliminary Observations Using an 810 nm Diode Laser. Dermatol Surg, 2001; 27: 117.
[21]Mathewson K. Lowpowerlaser hyperthermia. In: Krasner N(ed): Lasers in Gastroenterology. London, Chapman &Hall Medical, 1991; 281.
[22]Robert J. Min, MD, Steven E. Zimmet, MD, Mark N, et al. Endovenous Laser Treatment of the Incompetent Great Saphenous Vein. Vascular and Interventional Radiology, 2001; 10(12), 1167.
[23]王嘉桔，张静菊．下肢静脉曲张加压硬化剂疗法的有关问题．普通外科杂志，1999；6(14)：461．
[24]Kister RL, Ekolof B, Masuda EM. Deep venous valve reconstruction. Cardio vascular Surg, 1995; 3(2): 129.
[25]吴丹明，董齐，易巍，等．电凝术治疗下肢静脉曲张27例临床分析．中国实用外科杂志，2002；22(2)：99．