目的

探讨腔内激光消融（EVLT）联合泡沫硬化术治疗下肢静脉曲张的临床疗效。

方法

2011年6月—2012年12月，收集采用EVLT联合泡沫硬化术治疗下肢静脉曲张患者101例（120条肢体）。101例患者均先行大隐静脉高位结扎；104条肢体从大隐静脉结扎处穿刺逆行送入激光导丝闭合大隐静脉主干，16条肢体从足踝处穿刺顺行送入激光导丝闭合大隐静脉主干；头皮针穿刺大隐静脉属支和曲张静脉团块见回血后，注入聚桂醇和空气（按1∶4比例配制）混合泡沫；溃疡患者，距离溃疡边缘约1 cm，环形注射聚桂醇纯液。

结果

101例手术均获成功，单侧手术平均时间为46 min，双侧手术平均时间为81 min；住院时间平均4 d。3例患者术中出现胸闷，未经处理自行好转；2例患者出现咽喉瘙痒、咳嗽及皮疹等过敏症状，经抗过敏处理后缓解。术后随访3～14个月，2例部分曲张静脉残留，经再次泡沫硬化治疗而痊愈；16例活动性溃疡的患者，1例未愈，2例术后6个月复发；11例患者发生血栓性静脉炎，经理疗后痊愈。

结论

腔内激光消融及泡沫硬化术治疗下肢浅静脉曲张简便、安全、有效、并发症少。

Objective

To evaluate the efficacy and safety of endovenous laser treatment（EVLT）combined with foam sclerotherapy for varicose veins of the lower limbs.

Methods

A total of 101 cases（120 limbs）of lower extremities varicosity patients were treated with EVLT combined with foam sclerotherapy from June 2011 to December 2012，with proximal ligation of the great saphenous vein（GSV）performed first.After inserting retrogradely（from the point of ligation of GSV to ankle）or anterogradely（from ankle to the ligation of GSV）the optical fiber，the trunk of the GSV was treated with EVLT at a wave length of 810 nm.Sclerosing foam（a mixture of 1 ml lauromacrogol solution with 4 ml air）was then injected into the tributary of the GSV and varicose vein cluster.

Results

EVLT combined with foam sclerotherapy was performed successfully in all 101 cases at an average hospital stay of 4 days.Three patients developed chest tightness which improved spontaneously without specific treatment.Two patients were complained post-operatively of itchy throat and cough which relieved after anti-allergy treatment.Patients were followed up for 3-14 months，and 2 cases of partial residual varicose veins were treated by foam sclerotherapy again.Sixteen patients presented with active ulcer.Wound healing was achieved in 13 cases，1 case remained unhealed，and relapse was seen in 2 cases after 6 months.Eleven cases with thrombophlebitis were managed with physiotherapy.

Conclusions

EVLT combined with foam sclerotherapy is an effective approach with minimal invasion，simple manipulation and less complications.