【作者】 董文尧；

【导师】 金星；

【作者基本信息】 山东中医药大学 ， 中医外科学， 2003， 硕士

【摘要】 目的 观察血管腔内激光术治疗下肢静脉曲张的临床疗效并初步探讨其作用机理。方法 78例单纯性下肢静脉曲张患者或原发性下肢深静脉瓣膜功能不全并浅静脉曲张患者随机分为治疗组35例(40条患肢)和对照组43例(44条患肢)，治疗组以血管腔内激光术治疗，对照组以传统的大隐静脉高位结扎、分段剥脱及交通支结扎术治疗。观察两组患者术前、术后的一般情况、症状体征的变化以及术后并发症，同时观察治疗组术前、术后的多普勒检查、病理检查结果。结果 与对照组相比较，激光治疗术能明显减少手术时间、术后肢体疼痛时间及住院天数，两者有显著性差异(P＜0.01)，治疗组患者术后恢复快；并发症：皮下血肿、患肢皮肤感觉麻木及切口愈合率治疗组均明显优于对照组，两者有显著性差异(P＜0.05，P＜0.01)；对于患者症状体征的改善两组无显著性差异(P＞0.05)；治疗组术后的病理检查结果显示激光治疗术后的静脉内、中、外膜的变性、坏死，无炎性细胞浸润；多普勒检查显示40例(100％)大隐静脉主干内均无血流显示，其直径平均较术前缩小27.16％，仅3例(7.50％)发现分支静脉中有缓慢线状血流信号。结论 血管腔内激光术是一种近期疗效良好的手术方法，具用微创、并发症少、患者恢复快等优点，其作用原理是通过光热作用利用激光转化产生的热能破坏静脉壁，使其达到纤维化，管腔闭塞，从而达到治疗目的。更多还原

【Abstract】 Objective To observe the clinical effect of EndoVenous Laser Treatment for lower extremity varicose veins and study its therapeutic mechanism, introduce a new operative method. Methods seventy-eight patients of lower extremity varicose veins were divided randomly into therapy group (35 cases, 40 legs) and control group (43 cases, 44 legs). The therapeutic group was received endovenous laser treatment and the control group was given surgical ligation and stripping . The changes of clinical symptoms in all patients were observed before and after treatment. In additional, we observed the changes of Doppler examination and veins’ pathology of the EVLT group. Results The patients of the therapeutic group recovered more quickly and the side effects were less than the control group. These changes were statistically different compared with those of the control group, P<0. 05, P<0.01. The two groups’ effects on improving the symptoms were not different. The changes were statistically identical, P>0.05. The pathology’ s variation was retrogression and necrosis of the wall of the veins, and there were no inflammatory cell infiltrating. The results of the Doppler examination after treatment showed the GSVs were all closed (100%), and the GSVs’ mean diameter reduced 27. 16%. Furthermore, we discovered prosodemic flood flow in ramose veins in 3 cases (7.50%). Conclusion The endovenous laser treatment appears to be a new method with good short-term results. The EVLT has advantages ofminimal invasion, less side effects and less time of the patients’ recovery. Its therapeutic mechanism is utilizing the heat emitted by the laser sight to destroy the wall of the veins. The veins are gradually fibroid and close at last. But the long-term follow-up is awaited.更多还原