Endovenous Laser Treatment for Varicosities in Lower Extremities

以靜脈內雷射治療術治療下肢靜脈曲張症

詹志洋(Chih-Yang Chan) ； 李紹榕(Shao-Jung Li) ； 邱冠明(Kuan-Ming Chiu)

《Formosan Journal of Surgery》 39卷3期 (2006/06) Pp. 113-118

https://doi.org/10.29833/FJS.200606.0001

摘要

回顧分析本院合併使用靜脈內雷射、微創曲張鉤除、與硬化劑等微創方式治療台灣下肢靜脈曲張症病人的中期結果與經驗。
我們使用超音波導引技術與充盈式麻醉技術進行手術，「穿式」或「刺式」微創傷口以放置導引鞘與雷射光纖，並且使用波長810nm diode靜脈內雷射以阻斷逆流的靜脈主幹。通常雷射強度設定在10-14 watts，自隱股靜脈接合處以下4-5cm開始治療，通常結束於膝部左右，並且不超過膝下10cm。如果病人下肢靜脈曲張很突出，我們會在同一次手術中合併使用米勒式微創鉤除術或硬化劑注射治療。我們指導病人術後立即恢復行走與活動，安排門診追蹤以紀錄手術後疼痛指數，追蹤雷射成效。
本院於2003年10月到2004年12月間，以合併微創方式治療102病人，118下肢靜脈曲張。由於使用超音波導引與充盈式麻醉技術，所有病例都成功置放雷射光纖並且接受靜脈內雷射治療。使用的雷射發射速度平均為43.68±27.28 joules/cm，雷射流平均為18.47±13.48 joules/cm square，結果顯示隱靜脈閉合成功率96.61%。如果使用雷射發射速度大於17.24 joules/cm或是雷射流大於5.49 joules/cm square，成功率為100%。有32例在同一次手術中合併米勒式微創鉤除術，33例接受硬化劑注射治療。所有的病人都能在手術後立即恢復行走，並且不需要住院。術後1-3日疼痛指數是2.94±1.91，沒有發生顯著併發症。
對於台灣患有下肢靜脈曲張症病人，使用超音波導引與充盈式麻醉技術，合併靜脈內雷射、米勒式鉤除術、與硬化劑注射治療可以安全、有效地，在門診手術執行。不需要臥床休息，也不需要住院。病人在手術後就能夠恢復行動。有效治療台灣病人靜脈曲張主幹所需要的雷射能量可能比西方人所需要的較低。

並列摘要

Objective: To retrospectively analyze the results of treatment on Taiwanese patients with primary varicosities of the lower extremities including concomitant use of endovenous laser, phlebectomy, and sclerotherapy.
Methods: We routinely used tumescent anesthesia and ultrasound-guided approaches for the application of endovenous laser. Vein access was achieved by either a percutaneous or stab wound. The laser power was usually 10-14 watts, laser treatment usually was begun from 4 cm below the saphenofemoral junction, and stopped around the knee, not over 10 cm below the knee. In the same operation, we used Mueller s phlebectomy and/or sclerotherapy if there were prominent branch varicosities. We instructed each patient to walk around immediately after the operation, to go home, and to come back 1-3 days later for follow-up.
Results: One hundred and eighteen limbs in 102 patients were treated with the ambulatory method from October 2003 to December 2004. Using ultrasound-guidance and perivenous tumescent anesthesia, endovenous placement of laser fiber was achieved in each case. The laser delivery rates we used were 43.68±27.28 joules/cm, with fluency of 18.47±13.48 joules/cm square. The mid-term results 12 to 24 months after surgery indicated a 96.61% success rate. There was no failure when laser fired above 17.24 joules/cm or 5.49 joules/cm square. Thirty-two (32) limbs had concomitant Mueller s ambulatory phlebectomies and 33 limbs sclerotherapies. All patients could walk around immediately after the treatment. The 1st - 3rd postoperative day pain score was 2.94±1.91, and no serious complications occurred.
Conclusions: With the use of ultrasound guidance and tumescent anesthesia, endovenous laser treatment with concomitant phlebectomy and sclerotherapy for primary varicosities of the lower extremities can be safely and effectively done on an out-patient basis for Taiwanese patients. Neither bed-rest nor hospitalization is necessary.

並列關鍵字

varicosities ； endovenous ； tumescent