【摘要】 目的探讨改良微创剥脱联合电凝术治疗下肢大隐静脉曲张的疗效。方法 2005年1月～2010年1月,对891例(957条)下肢大隐静脉曲张行改良微创剥脱联合电凝术:保留旋髂浅静脉、腹壁浅静脉、阴部外静脉,剥脱大隐静脉主干,再联合电凝法处理曲张的浅静脉。术后2周、1个月、3个月和每年来院复查,应用彩超检查是否有深静脉血栓或再发新的曲张静脉,随访症状改善情况,是否有神经损伤及溃疡愈合情况。结果单侧肢体手术时间25～40 min,平均32 min。住院时间3～5 d,平均4.3 d。下肢溃疡69例术后溃疡愈合时间平均6.1周(2～11周)。术后无下肢深静脉血栓发生,无皮肤灼伤发生,内踝处伤口周围皮肤麻木52例,术后自行恢复。796例随访1～5年,随访率89.3%(796/891),复发24例,复发率3.0%(24/796),再次手术或电凝闭锁。对复发危险因素进行单因素和多因素分析logistic回归分析显示:体重指数(BMI)>33.4、曲张静脉直径>8.7 mm是静脉曲张复发的独立危险因素。结论改良微创剥脱联合电凝术治疗下肢大隐静脉曲张是一种安全、有效的方法。更多还原

【Abstract】 Objective To analyze the clinical outcomes of modified microphlebectomy combined with endovenous electric coagulation in the treatment of varicose great saphenous veins.Methods From January 2005 to January 2010,we performed modified microphlebectomy combined with endovenous electric coagulation on 957 limbs in 891 patients.The procedure included preservation of the superficial iliac circumflex vein,superficial epigastric vein,and external pudendal vein;stripping of the great saphenous vein;and endovenous electrocoagulation of the superficial varicose veins.Follow-up visit was paid at 2 weeks,1 month,3 months,and then annually after the surgery to assess the improvement of symptoms,deep venous thrombosis(DVT),recanalization of the ablated vein,nerve injury and ulcer healing.Results The operation time was 25-40 minutes(mean,32 minutes) for each limb.The mean hospital stay of the patients was 4.3 days(ranged from 3 to 5 days).The 69 ulcers showed healing at a mean of 6.1 weeks(range,2-11 weeks).No deep vein thrombosis and skin burns occurred.Local transient paresthesia at the ankle occurred in 52 patients and then all recovered spontaneously.A follow-up for 1 to 5 years were completed in 796 cases(follow-up rate: 89.3%).During the follow-up,24 patients(3.0%) received a second operation or endovenous electric coagulation for recanalization.Logistic regression showed that body mass index >33.4 and a vein >8.7 mm in diameter were the independent risk factors of recanalization.Conclusion Modified microphlebectomy combined with endovenous electric coagulation is safe and effective with low complications and recurrence rates.更多还原