OBJECTIVE: Retrospective clinical analysis of primary surgical operation in the treatment of lower limb accompanied by chronic leg ulcer were adopted in this study. METHODS: From September 1990 to June 1998, there were 31 males and 20 females, aged 68 years in average, the area of ulcer varied from 5 cm x 3 cm to 22 cm x 11 cm. The ligation and strip of saphenous vein, debridement and free skin flap grafting were finished in primary operation. RESULTS: The skin flaps were survived completely in 50 cases, only 1 case was necrosis partially and healed after changing dressing. Forty-two cases were followed up for 16 months to 9 years (66 months in average), the varicosis and ulcer were healed in 39 cases and only 3 relapsed in ulceration. CONCLUSION: Primary surgical operation in the treatment of varicosis of lower limb accompanied by chronic ulcer is practicable in clinic. The curative efficacy is satisfactory and the operative manipulation is simple.
目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
目的 研究地佐辛＋咪达唑仑在大隐静脉射频闭合术中的镇静作用，并观察其对生命体征的影响以及不良反应的发生情况。方法 选取60例行大隐静脉射频闭合术患者，根据麻醉方式分为芬太尼＋咪达唑仑组和地佐辛＋咪达唑仑组２组，每组30例。分别监测心率（HR）、动脉血氧饱和度（SpO2）、平均动脉压（MAP），记录用药后5min和30min的镇静评分、生命体征以及术中不良反应的发生情况。结果 给药后5min和30min的镇静效果评分芬太尼＋咪达唑仑组分别为（2.95±0.14）分和（4.09±0.05）分，地佐辛＋咪达唑仑组分别为（3.16±0.09）分和（4.08±0.08）分，2组比较差异无统计学意义（P＞0.05）。2组给药后5min和30min的HR、SpO2及MAP比较差异均无统计学意义（P＞0.05）；与给药前（0min）比较，差异也无统计学意义（P＞0.05）。2组患者镇静良好，无躁动，均无一例发生呼吸抑制，仅芬太尼＋咪达唑仑组有4例发生呛咳。结论 芬太尼和地佐辛联合咪达唑仑用于大隐静脉射频消融手术患者，镇静效果良好，对生命体征影响小，但地佐辛组无呛咳，不良反应发生率更低。
Objective To explore the feasibility and the security of one-day stay ward in stripping surgery of saphenous vein varicosity. Methods Two hundred and eighty two patients treated in our hospital in 2011 were enrolled in this study， according to the operation mode， these patients were divided into 2 groups， ninety patients in one-day stay ward group and one hundred and ninety two patients in in-patient group. Their clinical features and medical operation indexs（included preoperative waiting time， duration of hospital stay， and medical cost）were retrospectively analyzed. Results There was no statistical differences on clinical features between the two groups. But compared with in-patient group， the preoperative waiting time， duration of hospital stay， and medical cost were shorter or lower in one-day stay ward group （P＜0.05）. Conclusions The one-day stay ward operation mode can decrease preoperative waiting time， duration of hospital stay and medical cost significantly， and it also can ensure the safety of clinical treatment. So it’s worthy in the clinical promotion.
目的探讨大隐静脉腔内激光+膝下经皮点状贯穿缝扎治疗大隐静脉曲张的临床疗效。方法回顾性分析我院2004年1月至2010年12月期间389例大隐静脉曲张患者采用腔内激光+膝下经皮点状贯穿缝扎术治疗的临床资料。结果手术全部成功完成，平均手术时间50 min。住院4～8 d，平均住院6 d。本组患者均获随访，随访时间为 1～36个月（平均18个月），所有患者均无深静脉血栓、深静脉损伤等手术并发症发生，无一例复发。迂曲、成团曲张静脉消失,溃疡愈合，色素沉着减轻或消失，下肢肿胀沉重感、酸困感消失。术后1个月彩超复查大隐静脉主干均全程闭塞，无血流信号，曲张的静脉均消失，膝下小腿部皮肤无条索状硬结及瘢痕。结论大隐静脉腔内激光结合膝下经皮点状贯穿缝扎术，使微创治疗大隐静脉曲张更加完善。
目的 总结单纯性大隐静脉曲张的治疗经验。方法 回顾性分析我院2007年3月至2009年11月期间采用改进高位结扎及剥脱术治疗单纯性大隐静脉曲张65例患者的临床资料。结果 本组患者手术时间45～127 min，平均54 min。住院时间5～8 d，平均6.8 d。所有切口均甲级愈合，肿胀不适、沉重感等症状消失，切口皮下无出血、瘀血、血肿，无皮肤麻木等并发症发生。术后随访2～33个月，平均26.9个月，无一例发生深静脉血栓形成，均按期拆线，效果良好，无复发。结论 改进高位结扎剥脱术治疗单纯性大隐静脉曲张疗效确切。
ObjectiveTo evaluate optimal surgical timing of high ligation and ambulatory phlebectomy in treatment of primary great saphenous varicose vein. MethodsThe patients who met the inclusion criteria were divided into simple varicose vein (C2) group and soft tissue complications (C3-C4) group.All the patients were received high ligation and ambulatory phlebectomy.The surgery-related indexes,hospital costs,improvement of quality of life,postoperative recurrence rate were observed. ResultsAll the operations were successful.The operative time,the number of operative incision,and the hospital costs in the C2 group were significantly less than those in the C3-C4 group (P<0.05).The total postoperative complications rate in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative AVVQ score on month 3 in the C2 group was significantly lower than that in the C3-C4 group (P<0.05).The postoperative recurrence rate on month 3 had no statistical significance between these two groups (P>0.05). ConclusionsEarly stage (C2) is the optimal surgical timing of primary great saphenous varicose vein,benefits of surgery and health economics in early stage are significantly better than those in mid-advanced stage (C3-C4).It is suggested that surgery should be underwent at early stage in patients with primary great saphenous varicose vein.
Objective To compare scar and incision satisfaction between Prolene polypropylene suture and conventional silk suture for dermal suture in high ligation and stripping of primary great saphenous varicose vein. Methods A total of 83 patients who met the inclusion criteria were admitted in the West China Hospital, including 27 males and 56 females. The average age was 46.7 years old, ranging from 30 to 63 years old. Forty-two patients were grade C2 and 41 were grade C3 according to the CEAP grading. Patients were divided into a polypropylene suture group (even number,n=45) and a silk suture group (odd number,n=38) according to admission date order. Prolene 5-0 polypropylene suture was used for dermal suture in the patients of the polypropylene suture group and 1# silk suture in the patients of the silk suture group. The pigments of incision area and suture area and their widths, and the points of Patient and Observer Scar Assessment Scale score (POSAS) and patient and observer satisfaction score of incision were observed on month 6 for following-up. Results ① The gender, age, body mass index, and proportion of C2 of the CEAP grading or smoking had no significant difference between these two groups (P>0.05). ② All the operations were successful and all the patients were followed up. All the incisions healed well and had no infection. There was a few subcutaneous hematoma in one incisionof the 2 patients on day 3 after operation in the two groups, which markedly improved after dressing treatment. The sutures of all the patients were removed on day 14 after operation. ③ The pigment of incision area and its width, and the points of POSAS had no significant differences between the two groups (P>0.05). The pigment of suture area and its width, and the points of patient and observer satisfaction score of the incision in the polypropylene suture group were significantly better than those in the silk suture group (P<0.05). Conclusion Prolene polypropylene suture is preference to conventional silk suture in aesthetic results and patient satisfaction for dermal suture of great saphenous varicose vein surgery.
ObjectiveThis study is designed to explore the indications, clinical pathway, and benefits of ultrasound-guided local anesthesia in radiofrequency endovenous obliteration (RFO) for great saphenous vein varices (GSV).MethodsA total of 350 patients diagnosed with GSV were divide into observation group (n=175) and control group (n=175). Patients in the observation group underwent local anesthesia RFO, and patients in the control group underwent intravertebral anesthesia. Comparion in the visual analogue scale pain scores (VAS) when anesthesia and after surgery, operative indexes, recovery time, satisfaction, and complications were performed.ResultsCompared with the control group, the VAS score with anesthesia time were lower (P<0.05), while in the surgery were higher (P<0.05), as well as the operative time, the first time for underground activity, normal activity time, incidences of complication of anesthesia and urinary were shorter (P<0.05), and the satisfaction rate was higher (P<0.05). There was no difference in the pain score of 12 h and 24 h after surgery, blood loss, volume of anesthetic swelling fluid, postoperative hospitalization, incidences of urinary tract infection, incisional infection, and deep vein thrombosis (P>0.05).ConclusionsThe RFO is feasible and safe after local anaesthesia. It can decrease the complication of anesthesia, that will promote the patient soon to be restored to health.