静脉腔内激光治疗下肢静脉曲张69例临床分析
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摘要
目的：评估静脉腔内激光治疗下肢静脉曲张的适应症﹑治疗效果及手术并发症；探讨EVLT的优缺点以及改进措施。
方法：对69例下肢静脉曲张患者103条患肢采用静脉腔内激光治疗。治疗后随访6～18月；统计术前与术后的各项资料并加以分析。
结果: 103条曲张患肢中的102条EVLT治疗后隐静脉完全闭塞，1例再次EVLT治疗后大隐静脉闭塞完全；另有3例患者3条4级患肢(2.91%)残留少量属支曲张静脉，共4处； EVLT治疗后常见的手术创伤反应有瘀斑﹑触痛﹑条索状硬块等，均在短期内减轻或消失，无严重的并发症发生；随访6～18月静脉曲张无复发。
结论：静脉腔内激光治疗是一种有效和安全的治疗下肢静脉曲张的新方法；适用于CEAP静脉功能分级C2～C5的原发性下肢静脉曲张患者；具有手术操作简便、痛苦轻、恢复快、并发症少、外表美观等优点；可以替代传统手术静脉曲张剥脱术；近期效果满意，远期效果有待进一步观察。
Objective: To assess the indication, preliminary efficacy and complication of Endovenous Laser Treatment (EVLT) for varicose veins of lower extremities and to investigate the improvement of EVLT.
Methods: A study was carried out on 103 limbs of 69 patients with varicose veins after proper patient selection. All limbs were treated by EVLT, and the follow-up of 6～18 months were evaluated to determine efficacy and complications of EVLT.
Results: The saphenous veins were closed in 102 of 103 lower extremities after EVLT, and one greater saphenous vein was closed after repeat treatment. Three cases left four isolated branch varicosities. The frequent traumatic response are ecchymoses, tenderness and induration. There were no significant complications and no recurrence at 6～18 months after EVLT.
Conclusion: Endovenous Laser Treatment is a safe and effective technique for the patient of clinical stages C2 to C5 with primary varicose veins of lower extremities. The easy operation and beautiful appearance
may make it a successful minimally invasive alternative for a wide group of patients that previously would have required ligation and stripping. The long-term results of EVLT need to study in spite of the early satisfied results.
方法：对69例下肢静脉曲张患者103条患肢采用静脉腔内激光治疗。治疗后随访6～18月；统计术前与术后的各项资料并加以分析。
结果: 103条曲张患肢中的102条EVLT治疗后隐静脉完全闭塞，1例再次EVLT治疗后大隐静脉闭塞完全；另有3例患者3条4级患肢(2.91%)残留少量属支曲张静脉，共4处； EVLT治疗后常见的手术创伤反应有瘀斑﹑触痛﹑条索状硬块等，均在短期内减轻或消失，无严重的并发症发生；随访6～18月静脉曲张无复发。
结论：静脉腔内激光治疗是一种有效和安全的治疗下肢静脉曲张的新方法；适用于CEAP静脉功能分级C2～C5的原发性下肢静脉曲张患者；具有手术操作简便、痛苦轻、恢复快、并发症少、外表美观等优点；可以替代传统手术静脉曲张剥脱术；近期效果满意，远期效果有待进一步观察。
Objective: To assess the indication, preliminary efficacy and complication of Endovenous Laser Treatment (EVLT) for varicose veins of lower extremities and to investigate the improvement of EVLT.
Methods: A study was carried out on 103 limbs of 69 patients with varicose veins after proper patient selection. All limbs were treated by EVLT, and the follow-up of 6～18 months were evaluated to determine efficacy and complications of EVLT.
Results: The saphenous veins were closed in 102 of 103 lower extremities after EVLT, and one greater saphenous vein was closed after repeat treatment. Three cases left four isolated branch varicosities. The frequent traumatic response are ecchymoses, tenderness and induration. There were no significant complications and no recurrence at 6～18 months after EVLT.
Conclusion: Endovenous Laser Treatment is a safe and effective technique for the patient of clinical stages C2 to C5 with primary varicose veins of lower extremities. The easy operation and beautiful appearance
may make it a successful minimally invasive alternative for a wide group of patients that previously would have required ligation and stripping. The long-term results of EVLT need to study in spite of the early satisfied results.
引文
★★★
JamesS.T.Yao,WilliamH.Pearce.PracticalVascularSurgery[M].NewYork.McGraw-Hill,1998：465.
张培华，蒋米尔，戴乐天，等.华东四省一市周围血管疾病调查研究[J].普外临床,1993，8：162
Conrad P.Groin-to-knee downward stripping of the long saphenous vein[J] . Phlebology, 1992,7:20-23
Kister RL. Primary venous valve incompetence of the leg [J]. Am J Surg, 1980,140: 218
孙建民，等.股浅静脉瓣膜修复术治疗原发性静脉功能不全的现况[J].国外医学外科学分册，1986，12：321
陈翠菊，等.股静脉瓣膜带戒术治疗下肢深静脉原发性瓣膜功能不全[J].中华外科杂志，1988，26：74
孙建民，张培华.自体带瓣膜静脉段股静脉移植术的进展[J].国外医学外科学分册，1986，13：343
蒋米尔，张培华.腘静脉外肌袢形成术近况[J].实用外科杂志，1991，11：478
Linton RR. Atlas of vascular surgery [M].Philadelphia: W.B.Saunders Co, 1973.57
Yamaki T,Nozak M, Sakurai H,et al.High resolution ultrasonographic scanning in the assessment of superficial Varicose vein[J]. Jpn J Phlebol,1995,6:411
Rutgers PH，Kitslaar PJ.Randomized tyial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein[J]. Am J Surg, 1994,168[3]:311
张东萍，何立纲，崔公让.下肢静脉曲张病因及治疗方法进展[J].中国中西医结合外科杂志，2002，8（1）：59-61
Proebstle TM，Lehr HA，Kargl A，et al.Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles，[J] Vasc Surg 2002，35:729-36
Proebstle TM，Sandhofer M，Kargl A，et al .Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood[J]. Dermatol-Surg. 2002 ,28[7]: 596-600
Min RJ, Zimmet SE, Isaacs MN, Forrestal MD.Endovenous laser treatment of the incompetent greater saphenous vein[J].J Vasc Interv Radiol ,2001,12:1167-71
Navarro L，Min RJ，Bone C.Endovenous laser: a new minimally invasive method of treatment for varicose veins preliminary observations using an 810 nm diode laser[J]. Dermatol Surg, 2001，27:117-122
Bernstein EF.Clinical characteristics of 500 consecutive patients presenting for laser removal of lower extremity spider veins[J]. Dermatol Surg,2001,27[1]: 31
Weiss RA.Comparison of endovenous radiofrequency versus 810 nm diode laser occlusion of large veins in an animal model[J].Dermatol Surg,2002 ，28[1]: 56-61
Campbell B. New treatments for varicose vein[J].BMJ ,2002，324:689-690
JamesS.T.Yao,WilliamH.Pearce.PracticalVascularSurgery[M].NewYork.McGraw-Hill,1998：465.
张培华，蒋米尔，戴乐天，等.华东四省一市周围血管疾病调查研究[J].普外临床,1993，8：162
Conrad P.Groin-to-knee downward stripping of the long saphenous vein[J] . Phlebology, 1992,7:20-23
Kister RL. Primary venous valve incompetence of the leg [J]. Am J Surg, 1980,140: 218
孙建民，等.股浅静脉瓣膜修复术治疗原发性静脉功能不全的现况[J].国外医学外科学分册，1986，12：321
陈翠菊，等.股静脉瓣膜带戒术治疗下肢深静脉原发性瓣膜功能不全[J].中华外科杂志，1988，26：74
孙建民，张培华.自体带瓣膜静脉段股静脉移植术的进展[J].国外医学外科学分册，1986，13：343
蒋米尔，张培华.腘静脉外肌袢形成术近况[J].实用外科杂志，1991，11：478
Linton RR. Atlas of vascular surgery [M].Philadelphia: W.B.Saunders Co, 1973.57
Yamaki T,Nozak M, Sakurai H,et al.High resolution ultrasonographic scanning in the assessment of superficial Varicose vein[J]. Jpn J Phlebol,1995,6:411
Rutgers PH，Kitslaar PJ.Randomized tyial of stripping versus high ligation combined with sclerotherapy in the treatment of the incompetent greater saphenous vein[J]. Am J Surg, 1994,168[3]:311
张东萍，何立纲，崔公让.下肢静脉曲张病因及治疗方法进展[J].中国中西医结合外科杂志，2002，8（1）：59-61
Proebstle TM，Lehr HA，Kargl A，et al.Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles，[J] Vasc Surg 2002，35:729-36
Proebstle TM，Sandhofer M，Kargl A，et al .Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood[J]. Dermatol-Surg. 2002 ,28[7]: 596-600
Min RJ, Zimmet SE, Isaacs MN, Forrestal MD.Endovenous laser treatment of the incompetent greater saphenous vein[J].J Vasc Interv Radiol ,2001,12:1167-71
Navarro L，Min RJ，Bone C.Endovenous laser: a new minimally invasive method of treatment for varicose veins preliminary observations using an 810 nm diode laser[J]. Dermatol Surg, 2001，27:117-122
Bernstein EF.Clinical characteristics of 500 consecutive patients presenting for laser removal of lower extremity spider veins[J]. Dermatol Surg,2001,27[1]: 31
Weiss RA.Comparison of endovenous radiofrequency versus 810 nm diode laser occlusion of large veins in an animal model[J].Dermatol Surg,2002 ，28[1]: 56-61
Campbell B. New treatments for varicose vein[J].BMJ ,2002，324:689-690