Objective To summarize research progress of postoperative complications of transilluminated powered phlebectomy in treatment of varicose veins. Method The clinical and scientific research about the treatment of varicose veins with transilluminated powered phlebectomy in recent years were searched and the progress of the postoperative complications were reviewed. Results With the evolution of surgical techniques and the accumulation of experience, a variety of translucent resection of the postoperative complications such as the cellulitis, wound abscess, hematoma, residual vein, nerve damage reduced. Conclusions From current development trend, incidence of complications after transilluminated powered phlebectomy might continue to decline. It has a potential to become a mainstream surgical technique for varicose veins in future.
目的 观察高位结扎联合腔内激光治疗大隐静脉曲张的疗效。 方法 回顾性分析2008年4月-2009年4月采用高位结扎联合腔内激光治疗32例大隐静脉曲张患者的临床资料，并与2003年-2008年采用传统手术方法治疗的61例患者进行对照分析。 结果 采用高位结扎联合腔内激光治疗的患者1例伤口感染，1例手术后患肢疼痛，3例手术后3个月局部轻度曲张；其余患者下肢症状减轻或消失，手术后1个月复查时活动均无障碍，无下肢深静脉血栓形成，无下肢深静脉损伤发生。高位结扎联合腔内激光治疗与传统手术方法比较具有切口少、出血量小、手术时间短、恢复快、住院时间短、手术后并发症较少、复发率低等优点。 结论 高位结扎联合腔内激光治疗大隐静脉曲张是一种安全有效的治疗方法，与传统手术比较具有明显优势。
ObjectiveTo analyze the causes of lower extremity varicose veins and assess the value of deep vein imaging in diagnosing and treating venous diseases, according to deep vein angiography examination results under digital subtraction angiography. MethodsDuring January 2012 to January 2013, 689 cases of lower limb varicose veins in 394 patients underwent lower extremity deep venous anterograde contrast examination, among which 87 patients also underwent left femoral venous trocar puncture angiography examination and 46 patients underwent femoral vein puncture inferior vena cava angiography examination at the same time. Then the results of imaging data were analyzed. ResultsThe causes of lower limb varicosity, according to its incidence, were as follows:primary deep venous valve incompetence (349 limbs of 184 patients) accounting for 50.7%, simple varicose veins of lower limbs (148 limbs of 95 patients) accounting for 21.5%, left iliac vein compression syndrome (121 limbs of 69 patients) accounting for 17.6%, cloth plus syndrome (54 limbs of 34 patients) accounting for 7.8%, post-thrombotic syndrome (16 limbs of 11 patients) accounting for 2.3%, and Klipple-Trenaunay syndrome (1 patient) accounting for 0.1%. ConclusionVaricose vein of lower limb is a common clinical manifestation of a variety of diseases, and the primary deep venous valve incompetence is the leading cause. Varicose veins of lower limb deep vein angiography is a reliable method for examination of lower extremity venous disease, and a basis for the choice of other treatments as well.
目的 探讨肝硬变门脉高压上消化道出血的原因及临床特点。方法 对121例肝硬变门脉高压伴上消化道出血患者急诊胃镜检查(48小时内)结果进行了分析。结果 本组病例中肝硬变非食管静脉曲张破裂出血占肝硬变上消化道出血病例的33%(40/121)，其中门脉高压性胃病24例，消化性溃疡12例，胃癌及病灶不详4例。结论 肝硬变非食管静脉曲张破裂所致出血中以肝硬变门脉高压性胃病出血最为多见，其出血方式各异，出血量大小不等，有诱因者较多，并发症亦较多。临床上应注意与食管静脉曲张破裂出血鉴别。
【摘要】 目的 探讨无痛胃镜两种方式——清醒镇静和静脉麻醉下治疗食管静脉曲张或出血的可行性。 方法 2004年11月-2008年5月， 根据病情或患者要求，对13例患者行清醒镇静即静脉推注咪达唑仑+芬太尼，30例行静脉麻醉即静脉推注咪达唑仑+丙泊酚。43例患者中36例行套扎治疗，7例行1%乙氧硬化醇注射治疗。 结果 43例均成功完成治疗，急诊止血率100%（11/11），治疗后4周复查，显效24例，占55.8%，有效17例，占39.5%，无效2例，总有效率95.3%。静脉麻醉组术后遗忘度100%，清醒镇静组插镜过咽和治疗过程中发生恶心分别为76.9%、46.1%。两组患者在治疗过程中及治疗后均未发生大出血。 结论 无痛胃镜下行食管静脉曲张治疗安全、疗效确切，以硬化剂注射治疗者应采用静脉麻醉。【Abstract】 Objective To observe the effect of painless gastroscopy- conscious sedation and intravenous anesthesia on treating esophageal varices or bleeding. Methods From November 2004 to May 2008, according to the disease condition or patient′s requirements, anesthetists assessed 13 patients who underwent conscious sedation with the intravenous injection of midazolam + fentanyl; 30 patients underwent intravenous anesthesia with intravenous injection of midazolam+propofol. Thirty-six patients underwent set tie treatment, and seven underwent 1% aethoxysklerol injection therapy. Results AN of the 43 patients completed the treatment successfully, and the emergency bleeding rate was 100% (11/11). Four weeks after the treatment, 24 cases had apparent therapeutic effect, accounting for 55.8%; 17 patients had effect, accounting for 39.5%; 2 patients had no effect; the total effective rate was 95.3%. The postoperative forgotten degree of the patients in intravenous anesthesia group was 100%. The nausea rate happened during the mirrors inserting and treatment in the conscious sedation group was 76.9% and 46.1%, respectively. No hemorrhage occurred in both of the tow groups. Conclusion Painless endoscopic is safe and effective for esophageal varices. Intravenous anesthesia should be used in Sclerotherapy.
From Oct. 1993 to Dec. 1995, nineteen refractory cases with varicosis and chronic ulcer of lower limb were treated. The average age of these patients was sixty-eight, the disease history was more than 20 years. The size of the ulcer of the leg ranged from the minimum of 10 cm x 8 cm to the maximum of 30 cm x 15 cm. All of them had once received saphenectomy and split skin graft without ulcer healing before they were admitted in our department. Both venography and ultrasonography showed superficial venous valve incompetence. The following comprehensive treatment was adopted. Firstly, myoplasty around popliteal vein was done. Secondly, phlebexairesis and phleborrhaphy were done for the variciform veins through minor incision. Then through debridement of the ulcer was performed. Delayed split skin graft was exerted one week later. The result showed that all the cases were successful: the ulcer was healed and there was no recurrence of varicosis.
ObjectiveTo evaluate feasibility and clinical effect of individual therapy for venous ulceration of lower extremity. MethodsFrom February 2012 to February 2014, 360 cases (totally 421 lower limbs) treated by the individual therapy were analyzed retrospectively. There were 126 male and 234 female patients, with a mean age of 53 years (ranging from 45 to 78 years). The venous ulceration occurred in left limb for 176 cases, right limb for 123 cases, and both limbs for 61 cases. The individualized treatment plans were performed for all the patients according to the color Doppler before the operation. The perforating vein was ligated during the operation, and elastic stockings were wore after operation. The operation time, postoperative VAS pain score, perioperative complications, ulcer healing and recurrence were recorded. ResultsThe operations were completed in all the patients, the average operation time was 35 min. The average VAS pain score was 2.6 at 8 h after operation, the pain was disappeared nearly at 24 h after operation. The time of returning to normal activity was 3 d. The incision bleeding occurred in 5 cases, the ulcer infection occurred in 32 lower limbs. The patients were followed-up for 12 months to 24 months, all the ulcers were healed, there were 9 cases of recurrence. ConclusionIndividual therapy for venous ulceration of lower extremity is safe, effective, fewer complications, fast ulcer healing, and less postoperative pain.
目的观察特利加压素联合生长抑素治疗肝硬变门静脉高压食管胃底曲张静脉破裂出血的效果。 方法我院2008年3月至2012年8月期间收治的47例肝硬变门静脉高压食管胃底曲张静脉破裂出血患者入院时采用掷硬币法被随机分为特利加压素＋生长抑素组（n=24）和生长抑素组（n=23），分别给予联合用药或单独使用生长抑素，计算24 h止血率、总止血率、1周再出血率、1周死亡率，观察不良反应发生、尿量及腹水量情况。 结果特利加压素＋生长抑素组24 h止血率、总止血率和不良反应发生率明显高于生长抑素组（P＜0.05），1周再出血率明显低于生长抑素组（P＜0.05），2组1周死亡率比较差异无统计学意义（P＞0.05），特利加压素＋生长抑素组尿量明显多于生长抑素组（P＜0.05），盆腔腹水量明显少于生长抑素组（P＜0.05）。 结论特利加压素联合生长抑素用于肝硬变门静脉高压食管胃底曲张静脉破裂出血止血效果确切，可以明显降低死亡率；虽然其不良反应发生率略高，但均可以控制。
目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。