摘要
目的 探讨下肢深静脉瓣膜关闭不全激光焊接修复的可行性,比较激光焊接修复和传统手术修复的优劣。方法 2014年10月至2017年10月,下肢深静脉瓣膜不全患者40例,均采用血管内激光光凝闭塞治疗。根据不同瓣膜修复方法随机分为两组,激光焊接组和传统对照组,每组患者20例。激光焊接组,采用股部3 cm微切口,暴露股浅静脉瓣环,利用波长1 470 nm激光折叠焊接瓣膜环,治疗功率6 W,缩窄管腔,进行瓣膜外修复。传统对照组,采用股部6 cm切口,显露并充分游离股浅静脉第一对瓣膜以上的深静脉,利用自体静脉片包裹瓣环,修复瓣膜。记录手术时间、切口大小、出血量、术后引流液量、下床活动时间、采用视觉模拟评分记录切口疼痛程度,观察切口肿胀和皮下瘀斑情况。手术后连续随访1~3年,比较两组患者治愈率。结果 20例激光焊接组患者手术顺利,手术时间和手术切口均明显小于传统对照组(P<0. 01);手术出血量、手术后引流液少于传统对照组(P<0. 01)。两组患者不良反应发生情况:激光焊接组无淋巴漏发生,传统对照组3例淋巴漏。术后疼痛较轻,主动下床活动时间较早(P<0. 05)。两组患者均达到临床治愈,随访1~3年均无复发病例,临床治愈率和随访结果无区别。结论 瓣膜外激光焊接纠正下肢深静脉瓣膜关闭不全,创伤小、恢复快,手术后反应轻,并发症少,明显优于传统外科手术方法,值得推广应用。
ObjectiveTo investigate the feasibility of laser welding for deep venous valve insufficiency and compare the advantages and disadvantages between laser welding and traditional surgery.MethodsTotally 40 patients with deep venous valve insufficiency were randomly divided into two groups:laser welding group and control group.In the laser welding group,3 cm microincision of femoral region was used to expose the superficial femoral vein valve annulus,and 3 W 1 470 nm laser to fold and weld the valve ring,constrict the lumen and repair the valve outside.In the control group,the deep veins above the first pair of superficial femoral veins were exposed and fully dissociated through a 6 cm incision of the femoral region.The valve was repaired with autologous vein flap.The varicose veins of both groups were treated by intravascular laser photocoagulation occlusion.The operation time,incision size,bleeding loss,wound drainage,time of moving out of bed were recorded.The pain degree of incision was recorded by visual analogue score,and the swelling and subcutaneous ecchymosis of incision were observed.The patients were followed up by 1-3 years post operation,and the cure rates were compared between the two groups.ResultsThe operation time in the laser welding group was significantly shorter than that in the control group(P<0.01),and the size of incision was much smaller in the laser welding group(P<0.01).No lymphatic leakage was found in the laser welding group,but there were 3 cases in the control group.Postoperative pain was mild and the time of active getting out of bed was earlier(P<0.05).All the patients in both groups were clinically cured,and no recurrence case was found during 1-3 years’follow-up.There was no difference between the two groups both in clinical cure rate and follow-up results.No recurrence case appeared in the follow-up.ConclusionsExternal laser welding is superior to the traditional surgical method in correcting deep venous valve insufficiency,which has the advantages of less trauma,faster recovery,l
作者
王春喜
徐明月
刘庆
疏丹
曾晶
顾瑛
杜毅
WANG Chun-xi;XU Ming-yue;LIU Qin;SU Dan;ZENG Jing;GU Ying;DU Yi(Department of General Surgery,Hainan Hospital of PLA General Hospital,Sanya 570003,China;Department of Laser Medical,No.1 Medical Central,Chinese PLA General Hospital;Department of Laser Medical Center,Hainan Hospital of PLA General Hospital;Department of Laser Clinic,Shenzhen Leimai Precision Medical Research Institute)
出处
《中国激光医学杂志》
CAS
2019年第3期121-125,共5页
Chinese Journal of Laser Medicine & Surgery
基金
国家重点研发计划(2018YFB0407203)
海南省重点研发计划(ZDYF2018101)
海南省自然基金创新团队项目资助(2017CXTD12)
三亚市医疗卫生科技创新项目资助(2017YW20)
解放军总医院转化医学项目资助(2016TM-36)
关键词
深静脉瓣膜关闭不全
激光焊接
微创手术
Deep venous valve insufficiency
Laser welding
Minimally invasive surgery
