超声引导下腔内激光闭合病理性穿支静脉治疗重度下肢静脉功能不全的临床疗效研究

王 忠臣, 王 鑫, 林 宇
大庆龙南医院血管外科 黑龙江 163000

摘要

目的：评价超声引导下腔内激光闭合病理性穿支静脉治疗重度下肢静脉功能不全的临床疗效。方法：选取我院2020年6月～2022年6月收治的57例（共84条下肢）重度下肢静脉功能不全的患者，应用超声引导下腔内激光闭合病理性穿支静脉。术后对患者进行随访。结果：全组术前经彩超、下肢静脉顺行造影显示的152支病理性穿支静脉（84条肢体）中，术中确认并微波腔内闭合149条（81条肢体），另有3条交通支静脉（3条肢体）术中未能明确。术后1周至3个月彩超复查显示，已处理的81条肢体中仅3条病理性穿支静脉（3条肢体）未完全闭合或再通。本组C6级34条患肢小腿溃疡愈合时间为8～92[平均（28.25±7.28）]d，其中溃疡直径<2cm的21条肢体愈合时间为8～31[平均（20.25±8.15）]d；溃疡≥2cm的12条肢体为15～92[平均（46.34±9.85）]d。术后3个月溃疡愈合率为98.06%，2例（5.80%）溃疡复发。本组C5和C6级84条患肢治疗3个月后，皮肤色素沉着、皮下脂肪硬化及水肿的改善率为92.75%。结论：超声引导下激光闭合病理性穿支静脉是一种治疗效果确切、操作简单、微创美观、并发症少的治疗方法。

关键词

下肢静脉功能不全；病理性穿支静脉；腔内激光闭合；超声引导；微创

参考

[1]Harlander-Locke M, Lawrence P, Jimenez J C, et al. Combined treatment with compression therapy and ablation of incompetent superficial and perforating veins reduces ulcer recurrence in patients with CEAP 5 venous disease[J].J Vasc Surg.2012,55(2):446-450.[2]罗云峰，张普生，邓鉴文.激光闭合在小腿交通支静脉功能不全治疗中的临床应用[J].中国血管外科杂志(电子版).2012,4(01):20-22.[3]孙建，赵振，秦金保，等.腔内激光闭合下肢曲张浅静脉术后复发的危险因素分析[J].中国血管外科杂志(电子版).2017,9(03):199-202.[4]Woodburn K R. Endothermal ablation for the treatment of clinically significant incompetent lower limb perforating veins: factors influencing the early outcomes[J].Phlebology.2021,36(2):127-134.[5]Lawrence P F, Alktaifi A, Rigberg D, et al. Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers[J].J Vasc Surg.2011,54(3):737-742.[6]Chehab M, Dixit P, Antypas E, et al. Endovenous Laser Ablation of Perforating Veins:Feasibility, Safety, and Occlusion Rate Using a 1,470-nm Laser and Bare-Tip Fiber[J].J Vasc Interv Radiol.2015, 26(6):871-877.[7]Hager E S, Washington C, Steinmetz A, et al. Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy[J].J Vasc Surg Venous Lymphat Disord.2016,4(1):51-56.[8] Park S W, Hwang J J, Yun I J, et al.Randomized clinical trial comparing two methods for endovenous laser ablation of incompetent perforator veins in thigh and great saphenous vein without evidence of saphenofemoral reflux[J].Dermatol Surg.2012,38(4):640-646.