透光動力旋切術治療下肢靜脈曲張的療效分析和手術體會_《中國普外基礎與臨床雜志》

作者：

朱遠志 , 羅軍 , 劉坤 , 揭月高

新疆醫科大學第一附屬醫院消化血管外科中心(烏魯木齊 830054);

關鍵詞：

透光動力旋切術大隱靜脈靜脈曲張血管外科手術美觀

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目的探討透光動力旋切術(旋切術)治療下肢靜脈曲張的療效、手術要點及臨床意義。方法我院自2006年5月至2009年11月期間收治下肢淺靜脈曲張患者255例(363條患肢)，其中男126例，女129例。按修訂后的CEAP臨床分級(clinical etiology anatomic and pathophysiological classification system)，C2級104條，C3級53條，C4級155條，C5級34條，C6級17條。均采用旋切術治療, 對患者進行術后隨訪，觀察術后并發癥發生情況。結果所有患者術前標記的曲張靜脈均被切除，手術時間單側患肢（100±20） min，雙側（147±19） min。術后221例患者（302條患肢）獲得隨訪，隨訪時間4～46個月，中位隨訪時間為24.5個月；其中術后1年以上的患者167例（247條患肢），獲得隨訪154例（229條患肢）。隨訪1年以上者中11條患肢復發，2條少量細小曲張靜脈殘留，術后1年以上復發率為5.68%（13/229）。21條肢體潰瘍于術后3～6周內愈合。術后并發癥： 16條肢體足踝部皮膚感覺異常或疼痛，經理療后3～6個月明顯好轉； 112條肢體有小腿皮膚瘀斑，于3～5周后吸收消退； 37條肢體出現小腿腫脹，于1～2周消退好轉; 2條肢體出現局部皮下血腫，5條肢體切口輕度感染，1條肢體內踝上方皮膚和皮下組織壞死，2條肢體腘窩處皮膚損傷，均經對癥處理后痊愈。結論下肢靜脈曲張的手術治療實際上是多種手術方法的聯合應用，旋切術治療下肢靜脈曲張的臨床初步研究表明，其具有安全、簡便、美觀的特點。

引用本文： 朱遠志,羅軍,劉坤,揭月高. 透光動力旋切術治療下肢靜脈曲張的療效分析和手術體會. 中國普外基礎與臨床雜志, 2010, 17(11): 1171-1174. doi: 復制

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7.	Fischer R, Chandler JG, Stenger D, et al. Patient characteristics and physician-determined variables affecting saphenofemoral reflux recurrence after ligation and stripping of the great saphenous vein [J]. J Vasc Surg, 2006; 43(1): 81-87.
8.	王深明. 靜脈疾病的臨床診斷和治療策略 [J]. 中國實用外科雜志, 2006; 26(10): 736-738.
9.	劉維藩，譚小宇，曾連山，等. 保留五大分支大隱靜脈次高位結扎術(附288例分析) [J]. 中國實用外科雜志， 1998; 18(8): 508-509.
10.	黃英，蔣米爾，張培華. 下肢淺靜脈曲張的微創治療 [J]. 外科理論與實踐， 2004; 9（1）: 76-77， 83.
11.	Elias SM, Frasier KL. Minimally invasive vein surgery [J]. Mt Sinai J Med, 2004; 71(1): 42-46.
12.	Shamiyeh A, Schrenk P, Huber E, et al. Transilluminated powered phlebectomy: advantages and disadvantages of a new technique [J]. Dermatol Surg, 2003; 29(6): 616-619.
13.	de Zeeuw R, Wittens C, Loots M, et al. Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results [J]. Phlebology, 2007; 22(2): 90-94.
14.	Aremu MA, Mahendran B, Butcher W, et al．Prospective randomized controlled trial: conventional versus powered phlebectomy [J]. J Vasc Surg, 2004; 39(1): 88-94.
15.	Scavée V. Transilluminated powered phlebectomy: not en-ough advantages? Review of the literature [J]. Eur J Vasc Endovasc Surg, 2006; 31(3): 316-319.
16.	Scavée V, Lesceu O, Theys S, et al． Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results [J]. Eur J Vasc Endovasc Surg, 2003; 25(5): 473-475.
17.	Nazarenko GI, Kungurtsev VV, Sidorenko VI, et al． Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins [J]. Angiol Sosud Khir, 2008; 14(2): 96-100.
18.	Chetter IC, Mylankal KJ, Hughes H, et al．Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veins [J]. Br J Surg, 2006; 93(2): 169-174.
19.	Hanrahan LM, Araki CT, Rodriguez AA, et al． Distribution of valvular incompetence in patients with venous stasis ulceration [J]． J Vasc Surg, 1991; 13(6): 805-812.
20.	Labropoulos N, Leon M, Geroulakos G, et al． Venous hemodynamic abnormalities in patients with leg ulceration [J]．Am J Surg, 1995; 169(6): 572-574.
21.	Padberg FT Jr. Endoscopic subfascial perforating vein ligation: its complementary role in the surgical management of chronic venous insufficiency [J]． Ann Vasc Surg, 1999; 13(3): 343-354.
22.	時德, 趙渝. 下肢慢性靜脈功能不全治療的再認識 [J]. 中國普外基礎與臨床雜志， 2009; 16（6）： 421-424.
23.	李昭輝, 景在平, 陳泉, 等. 腔鏡深筋膜下交通支結扎＋潰瘍周圍環縫術治療慢性下肢靜脈性潰瘍23例 [J]. 中國普外基礎與臨床雜志, 2008; 15（6）： 416-417.
24.	Passman MA, Dattilo JB, Guzman RJ, et al．Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? [J]. Vasc Endovascular Surg, 2007; 41(1): 41-47.
25.	Luebke T, Brunkwall J. Meta-analysis of transilluminated powered phlebectomy for superficial varicosities [J]. J Cardiovasc Surg (Torino), 2008; 49(6): 757-764.

1. Callam MJ. Epidemiology of varicose veins [J]. Br J Surg，1994; 81(2): 167-173.
2. 王深明. 下肢深靜脈瓣膜功能不全的外科治療 [J]. 中國普外基礎與臨床雜志, 2006; 13（6）： 629-631.
3. 陳孝平. 外科學 [M]. 北京：人民衛生出版社， 2005: 789-791.
4. Eklf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement [J]. J Vasc Surg, 2004; 40(6): 1248-1252.
5. Dwerryhouse S, Davies B, Harradine K, et al. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial [J]. J Vasc Surg, 1999; 29(4): 589-592.
6. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein [J]. J Vasc Surg, 2004; 40(4): 634-639.
7. Fischer R, Chandler JG, Stenger D, et al. Patient characteristics and physician-determined variables affecting saphenofemoral reflux recurrence after ligation and stripping of the great saphenous vein [J]. J Vasc Surg, 2006; 43(1): 81-87.
8. 王深明. 靜脈疾病的臨床診斷和治療策略 [J]. 中國實用外科雜志, 2006; 26(10): 736-738.
9. 劉維藩，譚小宇，曾連山，等. 保留五大分支大隱靜脈次高位結扎術(附288例分析) [J]. 中國實用外科雜志， 1998; 18(8): 508-509.
10. 黃英，蔣米爾，張培華. 下肢淺靜脈曲張的微創治療 [J]. 外科理論與實踐， 2004; 9（1）: 76-77， 83.
11. Elias SM, Frasier KL. Minimally invasive vein surgery [J]. Mt Sinai J Med, 2004; 71(1): 42-46.
12. Shamiyeh A, Schrenk P, Huber E, et al. Transilluminated powered phlebectomy: advantages and disadvantages of a new technique [J]. Dermatol Surg, 2003; 29(6): 616-619.
13. de Zeeuw R, Wittens C, Loots M, et al. Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results [J]. Phlebology, 2007; 22(2): 90-94.
14. Aremu MA, Mahendran B, Butcher W, et al．Prospective randomized controlled trial: conventional versus powered phlebectomy [J]. J Vasc Surg, 2004; 39(1): 88-94.
15. Scavée V. Transilluminated powered phlebectomy: not en-ough advantages? Review of the literature [J]. Eur J Vasc Endovasc Surg, 2006; 31(3): 316-319.
16. Scavée V, Lesceu O, Theys S, et al． Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results [J]. Eur J Vasc Endovasc Surg, 2003; 25(5): 473-475.
17. Nazarenko GI, Kungurtsev VV, Sidorenko VI, et al． Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins [J]. Angiol Sosud Khir, 2008; 14(2): 96-100.
18. Chetter IC, Mylankal KJ, Hughes H, et al．Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veins [J]. Br J Surg, 2006; 93(2): 169-174.
19. Hanrahan LM, Araki CT, Rodriguez AA, et al． Distribution of valvular incompetence in patients with venous stasis ulceration [J]． J Vasc Surg, 1991; 13(6): 805-812.
20. Labropoulos N, Leon M, Geroulakos G, et al． Venous hemodynamic abnormalities in patients with leg ulceration [J]．Am J Surg, 1995; 169(6): 572-574.
21. Padberg FT Jr. Endoscopic subfascial perforating vein ligation: its complementary role in the surgical management of chronic venous insufficiency [J]． Ann Vasc Surg, 1999; 13(3): 343-354.
22. 時德, 趙渝. 下肢慢性靜脈功能不全治療的再認識 [J]. 中國普外基礎與臨床雜志， 2009; 16（6）： 421-424.
23. 李昭輝, 景在平, 陳泉, 等. 腔鏡深筋膜下交通支結扎＋潰瘍周圍環縫術治療慢性下肢靜脈性潰瘍23例 [J]. 中國普外基礎與臨床雜志, 2008; 15（6）： 416-417.
24. Passman MA, Dattilo JB, Guzman RJ, et al．Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? [J]. Vasc Endovascular Surg, 2007; 41(1): 41-47.
25. Luebke T, Brunkwall J. Meta-analysis of transilluminated powered phlebectomy for superficial varicosities [J]. J Cardiovasc Surg (Torino), 2008; 49(6): 757-764.

《中國普外基礎與臨床雜志》

透光動力旋切術治療下肢靜脈曲張的療效分析和手術體會

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《中國普外基礎與臨床雜志》

透光動力旋切術治療下肢靜脈曲張的療效分析和手術體會

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