Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups: group A (102 cases)： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B (97 cases)： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group (group C). Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini-invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.
【Abstract】 Objective To study the outcome of wound-heal ing hydrogel in treating chronic venous ulcer of lowerextremities so as to find a new therapy. Methods From April 2007 to September 2007, 60 patients with chronic venous ulcer of lower extremities were randomly assigned to wound-heal ing hydrogel group (group A, 30 cases) and control group (normal sal ine, group B, 30 cases). In group A, there were 24 males and 6 females, aging (57.3 ± 6.8) years; the disease course was (2.9 ± 0.7) years; and the ulcer area was (3.4 ± 0.6) cm2. In group B, there were 20 males and 10 females, aging (60.1 ± 7.4) years; the disease course was (3.3 ± 0.9) years; and the ulcer area was (3.1 ± 0.4) cm2. There were no differences in age, area of ulcer and course of disease between two groups (P gt; 0.05). The area of ulcer was measured every week after the treatment, and the effect of treatmentwas evaluated after 15 days. Results The ulcer area of 7 days and 14 days after treatment was (2.6 ± 0.7) and (1.1 ± 0.2) cm2 in group A, and (2.8 ± 0.6) and (2.3 ± 0.7) cm2 in group B, respectively; showing no statistically significant differences 7 days after treatment (P gt; 0.05), and showing statistically significant difference 14 days after treatment between two groups (P lt; 0.05).The average heal ing time was (12.0 ± 1.7) days in group A, and (31.0 ± 2.9) days in group B, respectively, showing statisticallysignificant difference (P lt; 0.01). The results were excellent, good, fair and poor in 16, 9, 4 and 1 of group A , and were in 3, 9, 14 and 4 of group B, respectively; showing statistically significant difference (P lt; 0.01). Conclusion Wound-heal ing hydrogel is effective in treating chronic venous ulcer of lower extremities.
OBJECTIVE: To investigate the therapeutic effect of subfascial endoscopic perforator vein surgery (SEPS) in treatment of varicose of the lower limb. METHODS: From 1999. 11 to 2000. 12, 108 patients with varicose of the lower limb underwent venous surgery and 34 of them were treated by SEPS. There were 16 males and 18 females aged 20-79(averaged 51.4 years). Thirty limbs (26 cases) had open ulcers and the diameter of ulcer was 1.5-12.0 cm. Eleven limbs (8 cases) had severe pigmentation and the skin changes had been presented for 1 month to 15 years. According to the severity of illness, flush saphenofemoral ligation, great saphenous vein stripping, percutaneous continuous venous circum suture, external femoral vein valve repair and SEPS were performed separately or simultaneously. RESULTS: Active ulcers healed in 19 limbs after 1 month, in 7 limbs after 3 months, and in the other 4 ulcers after skin transplantation. There was no ulcer recurrence during follow-up (ranged 9-22 months). CONCLUSION: SEPS can accelerate the healing of venous ulcers, and it is one of important methods in the treatment of chronic venous insufficiency.
he fascia lata substitute valve operation was performed for curing the supperficial varieositycaused by the deep vein incompotence of the lower extremity basing on the study of the sources ofblood supply and the vascular distribution features of the fascia lata. The fascia lata subetitute vein valve operations were done on three males with the age rangingbetween 22 and 44 years old, and the rerelts were satisfactory 2 and 6 months after oporation.
目的 探讨泡沫硬化剂治疗复发性下肢静脉曲张的临床疗效。方法 选择我院2011年1月至2012年3月期间23例（26条患肢）复发性下肢静脉曲张的患者，其中男9例，平均年龄58.6岁；女14例，平均年龄53.3岁。静脉曲张复发病史1个月～6年，平均3.2年。对其行超声引导下患肢曲张静脉内注射1%聚桂醇泡沫硬化剂后弹力袜压迫，治疗后3d、3个月超声检测曲张静脉闭合情况及有无深静脉血栓形成，3个月后不定期病房随访。结果 23例患者均在超声引导下成功行泡沫硬化剂治疗，20例（22条患肢）注射1次，3例（4条患肢）注射2次，每例患者每次平均应用5ml泡沫硬化剂。末次注射结束后3d观察曲张静脉均成功闭合。平均随访6个月，治疗后1周2例出现轻度血栓性浅静脉炎，2周内自行缓解，均无严重并发症发生。治疗后3个月3例（4条患肢）局部复发，复发率15.4%，再次局部泡沫硬化剂治疗后至今未复发。10例（12条患肢）注射部位皮肤出现轻度色素沉着，3个月后减轻，6个月至1年消退。所有患者临床症状得到不同程度的缓解。结论 泡沫硬化剂治疗复发性下肢静脉曲张近期疗效确切且并发症少。
目的观察激光腔内闭合联合点式切除治疗下肢静脉曲张的疗效。方法回顾性分析我科2007年5月至2011年1月期间采用激光腔内闭合联合点式切除治疗310例下肢静脉曲张患者的临床资料，其中男121例，女189例，共406条肢体; 平均年龄52.6岁。结果所有患者术后临床症状得到改善，术后第3天查彩超显示所有大隐静脉主干完全闭合。36例合并皮肤溃疡患者中25例术后经换药后溃疡面明显缩小，11例术后3个月溃疡面愈合。术后有110例出现不同程度患肢皮下瘀斑，15例出现大隐静脉行程的皮下血肿，未予特殊处理，术后2~3周后均自行好转。术后出现小腿中下段内侧皮肤麻木及感觉障碍118例，术后3个月均有不同程度好转。所有患者切口一期愈合，无切口感染，未出现皮肤烧灼伤及术后下肢深静脉血栓形成。平均住院时间6.3 d。结论激光腔内闭合联合点式切除是治疗下肢静脉曲张的微创、安全及有效的方法。
Objective To compare the immediate therapeutic effects between endovenous laser treatment and conventional surgery for lower extremity varicosity. Methods Data of 350 limbs of 275 patients treated by endovenous laser treatment (endovenous laser treatment group) and 310 limbs of 210 patients by traditional surgery (traditional surgery group) were analyzed and compared in terms of operation time, number of the incision, postoperative pain, complications, postoperative hospitalized duration and 1-year recurrence rate. Results Endovenous laser treatment group had shorter operation time, fewer incisions, less postoperative pain and shorter postoperative hospitalized duration than traditional surgery group (Plt;0.05). The complications and 1-year recurrence rate had no significant differences between two groups (Pgt;0.05). Conclusion As a safe and effective new treatment for lower extremity varicosity with minimal invasiveness and no left scars, endovenous laser treatment has the potential to replace conventional surgery and extend the surgical indications for lower extremity varicosity treatment.
目的探讨低分子肝素预防下肢静脉曲张术后深静脉血栓形成的临床效果。 方法将2011年1月至2013年12月期间于笔者所在医院行大隐静脉高位结扎＋分段剥脱术＋腔内激光闭合术的513例下肢静脉曲张患者随机分为2组：低分子肝素组238例，下肢静脉曲张术后采用低分子肝素预防性治疗；对照组275例，术后不采用任何抗凝药物。比较2组患者深静脉血栓形成和并发症发生情况。 结果低分子肝素组发生浸透敷料的出血14例（5.9%），切口出血或皮下血肿25例（10.5%），血小板减少1例（0.4%），肝功能异常2例（0.8%），无深静脉血栓形成发生；对照组发生浸透敷料的出血19例（6.9%），切口出血或皮下血肿27例（9.8%），肝功能异常2例（0.7%），深静脉血栓形成7例（2.5%），无血小板减少发生。2组患者浸透敷料的出血、切口出血或皮下血肿、血小板减少及肝功能异常发生率比较差异均无统计学意义（P＞0.05），但低分子肝素组深静脉血栓形成的发生率低于对照组（P＜0.05）。术后获访487例，随访时间为4～12个月，平均10个月。其中低分子肝素组获访225例，对照组获访262例。获访患者随访期间发生下肢静脉曲张复发9例（低分子肝素组4例，对照组5例），隐神经损伤11例（低分子肝素组5例，对照组6例），无远期下肢深静脉血栓形成病例。2组患者的下肢静脉曲张复发率和隐神经损伤发生率比较差异均无统计学意义（P＞0.05）。 结论采用低分子肝素预防下肢静脉曲张术后下肢深静脉血栓形成具有良好的临床效果和安全性，值得临床推广应用。