目的 探討透光動力旋切術(shù)(旋切術(shù))治療下肢靜脈曲張的療效、手術(shù)要點(diǎn)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(shù)治療, 對患者進(jìn)行術(shù)后隨訪，觀察術(shù)后并發(fā)癥發(fā)生情況。結(jié)果 所有患者術(shù)前標(biāo)記的曲張靜脈均被切除，手術(shù)時(shí)間單側(cè)患肢（100±20） min，雙側(cè)（147±19） min。術(shù)后221例患者（302條患肢）獲得隨訪，隨訪時(shí)間4～46個(gè)月，中位隨訪時(shí)間為24.5個(gè)月； 其中術(shù)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(fù)發(fā)，2條少量細(xì)小曲張靜脈殘留，術(shù)后1年以上復(fù)發(fā)率為5.68%（13/229）。21條肢體潰瘍于術(shù)后3～6周內(nèi)愈合。術(shù)后并發(fā)癥： 16條肢體足踝部皮膚感覺異?；蛱弁?，經(jīng)理療后3～6個(gè)月明顯好轉(zhuǎn)； 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(xiàn)小腿腫脹，于1～2周消退好轉(zhuǎn); 2條肢體出現(xiàn)局部皮下血腫，5條肢體切口輕度感染，1條肢體內(nèi)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(jīng)對癥處理后痊愈。結(jié)論 下肢靜脈曲張的手術(shù)治療實(shí)際上是多種手術(shù)方法的聯(lián)合應(yīng)用，旋切術(shù)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(diǎn)。
引用本文： 朱遠(yuǎn)志,羅軍,劉坤,揭月高. 透光動力旋切術(shù)治療下肢靜脈曲張的療效分析和手術(shù)體會. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(11): 1171-1174. doi: 復(fù)制
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| 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(chǔ)與臨床雜志, 2006; 13（6）： 629-631. |
| 3. | 陳孝平. 外科學(xué) [M]. 北京： 人民衛(wèi)生出版社， 2005: 789-791. |
| 4. | Eklf 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(shí)用外科雜志, 2006; 26(10): 736-738. |
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| 10. | 黃英， 蔣米爾， 張培華. 下肢淺靜脈曲張的微創(chuàng)治療 [J]. 外科理論與實(shí)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(shí)德, 趙渝. 下肢慢性靜脈功能不全治療的再認(rèn)識 [J]. 中國普外基礎(chǔ)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(jié)扎＋潰瘍周圍環(huán)縫術(shù)治療慢性下肢靜脈性潰瘍23例 [J]. 中國普外基礎(chǔ)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(chǔ)與臨床雜志, 2006; 13（6）： 629-631.
- 3. 陳孝平. 外科學(xué) [M]. 北京： 人民衛(wèi)生出版社， 2005: 789-791.
- 4. Eklf 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(shí)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(jié)扎術(shù)(附288例分析) [J]. 中國實(shí)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(chuàng)治療 [J]. 外科理論與實(shí)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(shí)德, 趙渝. 下肢慢性靜脈功能不全治療的再認(rèn)識 [J]. 中國普外基礎(chǔ)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(jié)扎＋潰瘍周圍環(huán)縫術(shù)治療慢性下肢靜脈性潰瘍23例 [J]. 中國普外基礎(chǔ)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.